Kissing-stents技术治疗主-髂动脉闭塞症15例
Management of aorto-iliac occlusive disease by kissing-stents technique
目的 探讨kissing-stents(K型)技术腔内治疗主-髂动脉狭窄和闭塞性疾病的可行性.方法 回顾性分析2007年4月至2009年4月应用K型腔内成型技术治疗15例主-髂动脉狭窄闭塞性疾病患者的临床资料.其中男9例,女6例,平均66岁.全部病例有明显肢体缺血表现,其中:间歇性跛行11例(73%),平均距离88m.静息痛4例(27%),足趾坏死2例(13%).辅助检查提示:腹主动脉远端-双髂总动脉闭塞伴一侧股浅动脉局限性狭窄2例,双髂动脉狭窄伴闭塞3例,左侧髂总动脉闭塞伴双侧股浅动脉闭塞2例,右侧髂总动脉闭塞8例,其中4例伴有一侧股浅动脉狭窄和闭塞.全部患者ABI检查最低为0.0,最高为0.6,平均0.36±0.3.结果 15例患者应用K型技术均获成功,同时在双侧髂动脉内共植入40枚支架,平均每人植入2.7枚支架.其中15枚为自膨支架,25枚为球扩支架.治疗后血管造影显示,病变部位血管形态明显改善,管腔狭窄程度均<30%.病变血管近远端压力差平均为5 mm Hg.手术后肢体ABI测定:最低为0.5,最高为1.0,平均为0.8±0.2,与手术前相比平均提高0.44.全部患者的临床症状得到明显改善,平均住院日7 d.术后随访2年,原发性通畅率为87%,二次通畅率为94%.结论 应用腔内K型技术治疗主-髂动脉狭窄和闭塞性疾病是有效和安全的,可以明显提高手术的成功率,减少并发症的发生.
更多Objective To evaluate the place of kissing-stents technique in the management of aorto-iliac occlusive disease. Method Clinical data of 15 patients with aorto-iliac occlusive disease treated from Apr 2007 to Apr 2009 in our hospital were retrospectively analyzed. There were 9 males, and 6 females with a mean age of 66 years ( range 45-77 years). All 15 patients had significant symptoms of extremity ischemia. Claudication was complained in 11 (73% ) patients with an average distance of 88 meters. Four (27% ) patients had rest pain, gangrene of the toes was found in 2 patients ( 13% ). There were occlusive aorto- bilateral iliac artery with stenosis at superficial artery in 2 patients, occlusion at bilateral common iliac artery in 3 patients, occlusive disease at left common iliac artery with stenosis at bilateral superficial artery in 2 patients, occlusion at right common iliac artery in 8 patients, with stenosis or occlusion at superficial artery in 4 patients. In these 15 patients ABI was from 0.0 to 0.6, with an average of 0.36 ±0.3. Result Kissing-stents technique was successfully used in all 15 patients. 40 stents was released in bilateral common iliac arteries including 15 self-expanding stents and 25 balloon expandable stents. Residual stenosis was less than 30% and mean pressure gradient was 5 mm Hg. ABI increased from 0. 5 to 1.0 averaging at 0. 8 ±0. 2. The average hospitalization time was 7 days. Primary and secondary patency was 87% and 94% respectively as shown by a follow-up of 2 years. Conclusions Endovascular management of aorto-iliac occlusive disease by Kissing- stents technique is safe and effective and can raise the endovascular operation success rate and lower the complications.
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