腔内介入治疗在髂动脉闭塞性病变的临床应用效果

Clinical effect of intracavitary interventional therapy in iliac artery occlusion

摘要:

目的 探讨腔内介入治疗在老年人髂动脉闭塞性疾病中的临床效果。方法 回顾性分析2010年10月至2016年10月潍坊市人民医院血管外科收治的髂动脉闭塞性病变老年患者21例。术前均通过下肢动脉CT血管成像(CTA)予以诊断分析；并根据泛大西协作组织(TASC)予以分级。记录术前,术后3、6、12、24个月踝肱指数(ABI)变化、及术后髂动脉通畅率变化。采用SPSS 19.0软件对数据进行统计分析。计量资料采用t检验进行分析,通畅率应用Kaplan-Meier生存曲线分析。结果 对于髂动脉闭塞性病变,注意不同病变治疗方式的选择。血栓性闭塞可留置溶栓导管,溶栓治疗结束后,二次介入腔内治疗,选择髂动脉支架置入术；动脉硬化导致的髂动脉闭塞,一期行髂动脉球囊扩张术+髂动脉支架置入术。围手术期无死亡病例。术后3、6、12、24个月ABI分别为0.92±0.20、0.90±0.18、0.84±0.14、0.79±0.21,比术前显著改善提高,差异有统计学意义(P<0.01)。术后6、12、24个月髂动脉通畅率分别为95.7%、80.2%、72.9%。结论 全腔内治疗髂动脉闭塞性病变,创伤小,中期效果好,尤其适合老年患者。

Abstract:

Objective To investigate the clinical effect of intracavitary interventional therapy in iliac artery occlusion in the elderly.Methods A retrospective analysis was made of 21 elderly patients with iliac artery occlusion in the Department of Vascular Surgery of Weifang People′s Hospital from October 2010 to October 2016. All the patients were diagnosed by computed tomography angiography via the arteries in the lower extremity before operation and were graded according to the Trans-Atlantic Inter-Society Consensus. Changes of ankle-brachial index (ABI) were recorded preoperatively and postoperatively at 3,6, 12 and 24 months, and changes of patency rate of iliac artery were calculated. SPSS statistics 19.0 was used for data analysis. The measurement data were analyzed with t-test, and Kaplan-Meier survival curve analysis was performed for patency rate. Results Different treatment choice should be made for iliac artery occlusion of different lesions. Thrombolytic catheter can be retained for thrombolytic occlusion. In the case of iliac artery occlusion caused by arteriosclerosis, balloon dilatation of and stent implantation in the iliac artery were performed in the first stage. No perioperative death occurred. ABI was 0.92±0.20 at 3 months, 0.90±0.18 at 6 months, 0.84±0.14 at 12 months and 0.79±0.21 at 24 months after operation, being significantly improved as compared with that before operation (P<0.01). The patency rate was 95.7% at 6 months, 80.2% at 12 months, and 72.9% at 24 months. Conclusion Total intracavitary treatment of iliac artery occlusion is minimally invasive, and has good mid-term efficacy, which is particularly suitable for the elderly.