血管腔内技术治疗TASC C、D型主髂动脉病变的疗效分析

发布时间：2018-05-27 11:15

本文选题：主髂动脉闭塞症 + 血管腔内技术　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:腔内血管技术使主髂动脉疾病的治疗再上一台阶,随着技术的进步,包括高质量的影像技术、精密的器材、各种各样的支架及球囊的出现及不断完善,使血管腔内治疗的结果令人欣慰。与传统的血管旁路移植等外科手段的结果相比,血管腔内技术有其本身的优势。因此,血管外科医师们开始倾向于血管腔内治疗。目前,绝大多数的主髂动脉病变采用血管腔内技术治疗,而且随访结果令人满意。随着技术的不断更新,对于严重主髂动脉病变的复杂病例,血管外科医师也能够通过放置血管内支架的血管腔内技术及或开放手术或两者相结合的手段进行治疗。为了更进一步证明血管腔内技术在治疗主髂动脉疾病的临床结果。根据泛大西洋协作组织(Trans—Atlantic Inter—Society Consensus,TASC II)动脉疾病治疗指南,参考相关文献,探究我单位应用血管腔内技术治疗TASC C、D型主髂动脉病变的疗效。方法及结果:根据我单位2012年1月至2016年7月期间的资料。回顾性研究以血管腔内技术治疗主髂动脉闭塞性疾病,分析其疗效。依据泛太大西洋协作组织(Trans—Atlantic Inter—Society Consensus,TASCII)动脉疾病治疗指南,我单位在上述时间范围内收治TASC C、D型共367例,其中TASC C型244例,TASC D型123例,针对不同病例,予球囊血管成形术32例、支架200例:自膨式支架113例及覆膜支架87例、内膜下血管成形术共13例、内膜剥脱术联合血管腔内技术共77例、其他杂交术45例。对于髂总动脉闭塞,术中通过血管造影,主动脉分叉处予自膨式支架或覆膜支架重建,其直径在8-10mm;对于主动脉狭窄病例,支架直径选择20-25mm。所有病例术中手术过程顺利,且残余狭窄率皆低于30%,而且其并发症2.4%。术后采用多普勒超声和必要时血管造影进行随访,随访结果表明其第12、第18、第30、第42、第54个月的一期通畅率分别为97.2/95.8、95.2/94.6、85.5/84.3、79.3/77.8、77.6/75.5(TASC CD),二期通畅率均为100%。结论:血管腔内技术日新月异,是主髂动脉闭塞疾病安全、有效的治疗方案;对于复杂单侧髂动脉闭塞、对侧髂动脉高度狭窄、或者合并肾下主动脉闭塞的闭塞的病变,皆能通过极高的技术成功率获得满意的治疗效果;综合目前的随访结果和并发症等方面,可首选血管腔内技术治疗TASC C、TASC D型主髂动脉疾病。
[Abstract]:Objective: endovascular techniques have brought the treatment of major iliac artery diseases to a new stage. With the development of technology, including high quality imaging technology, precise equipment, various stents and balloon, The result of endovascular treatment is gratifying. Compared with the results of traditional surgical methods such as vascular bypass grafting, endovascular technique has its own advantages. As a result, vascular surgeons began to favour endovascular therapy. At present, most of the main iliac artery lesions are treated by endovascular technique, and the follow-up results are satisfactory. With the development of new techniques, vascular surgeons can also treat complex cases of severe major iliac artery disease by endovascular technique with stent placement, or open surgery or combination of both. To further demonstrate the clinical results of endovascular technique in the treatment of main iliac artery disease. According to the Trans-Atlantic Inter-Society Consensus TASCII-based guidelines for the treatment of arterial diseases, and with reference to relevant literature, we explored the efficacy of endovascular technique in the treatment of TASC Con D main iliac artery lesions. Methods and results: according to the data from January 2012 to July 2016. A retrospective study was conducted to evaluate the efficacy of endovascular technique in the treatment of major iliac artery occlusive diseases. According to the Trans-Atlantic Inter-Society Consensus-TASCII-based guidelines for the treatment of arterial diseases, 367 cases of TASC type C D were treated in our unit, including 244 cases of TASC C type, 123 cases of TASC D type. Balloon angioplasty was performed in 32 cases, stent in 200 cases: self-expandable stent (113 cases) and covered stent (87 cases), subintimal angioplasty (13 cases), endarterectomy combined with endovascular technique (77 cases), and other hybridization (45 cases). For common iliac artery occlusion, the diameter of self-expandable stents or covered stents was 8-10 mm by angiography, and the diameter of stent was 20-25 mm in aortic stenosis cases. The operative procedure was smooth and the residual stenosis rate was lower than 30% in all cases, and the complications were 2.4%. Doppler ultrasound and angiography were used to follow up the patients. The results showed that the patency rates of the 12th, the 18th, the 30th, the 42nd and the 54th month were 97.2 / 95.895 / 95.2 / 84.3 / 79.877.6and 75.5TASC respectively, and the patency rate of the second stage was 100. Conclusion: endovascular technique is a safe and effective treatment for the disease of main iliac artery occlusion, for complicated unilateral iliac artery occlusion, high contralateral iliac artery stenosis, or combined with subrenal aortic occlusion. The results of follow-up and complications showed that endovascular technique was the first choice for the treatment of TASC CTASC D main iliac artery disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.4

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