Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subdavian artery: Long-term results
Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subdavian artery: Long-term results
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DOI：
10.1016/j.jvs.2004.09.030
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发表时间：
2005-01-01
影响因子：
4.3
通讯作者：
Moll, FL
中科院分区：
文献类型：
--
作者：
de Vries, JPPM;Jager, LC;Moll, FL
目的：经皮腔内血管成形术（PTA）是锁骨下动脉局部阻塞的治疗方法之一。为了证明这种PTA的长期耐用性，我们报告了110例患者的10年单中心经验。从1993年1月至2003年7月，110名患者（72名女性;平均年龄62 ± 10岁）因症状性（>75%）狭窄（n = 90）或近端锁骨下动脉闭塞（84例左侧）接受了PTA。41例患者（37%）有椎基底动脉供血不足的症状，29例患者（26%）有致残性慢性手臂缺血，20例患者有两种症状。20例冠状动脉疾病患者接受了PTA，准备用乳内动脉进行心肌血运重建。多普勒扫描和动脉造影证实了严重的狭窄或闭塞。所有PTA手术均在患者局部麻醉下通过股动脉（n = 89）、肱动脉（n = 6）或联合途径（n = 15）进行。59例患者（58%）放置了额外支架。102例患者（93%）的血管成形术最初在技术和临床上成功。7例闭塞无法再通，1例因缺血性卒中不得不停止手术。在治疗成功的102例患者中，1例患者（1%）在PTA后2小时对侧半球发生轻微卒中。7例患者（7%）有轻微问题，均无永久性后遗症。随访时间3个月~ 10年，平均34个月。5年时的一期临床通畅率为89%，中位无复发梗阻期为23个月。局部并发症发生率为4.5%，合并卒中和死亡率为3.6%。8例有临床症状的患者发生了明显的复发性梗阻（>70%）。再次PTA成功治疗了4例狭窄（2例额外放置支架）; 4例闭塞需要手术。近端锁骨下动脉阻塞性病变的PTA不仅是一种有效的初始治疗方法，而且在长期内也是成功的。由于所有临床失败均发生在初始治疗后26个月内，因此我们建议PTA后定期随访至少2年。所有具有临床意义的复发性狭窄均可通过重复血管内手术治疗。我们无法证明额外置入支架的积极或消极影响;然而，在这项回顾性研究中，复发性狭窄的数量可能太少，无法得出确切的结论。任何类型的不良事件肯定不会比侵入性外科手术更严重。因此，对于锁骨下动脉近端局限性阻塞的患者，必须认真考虑PTA。
Purpose: Percutaneous transluminal angioplasty (PTA) is one of the treatment options for localized obstruction of the subclavian artery. To document long-term durability of this kind of PTA we report a 10-year single-center experience in 110 patients.Methods. From January 1993 to July 2003, 110 patients (72 women; mean age, 62 +/- 10 years) underwent PTA of symptomatic (>75%) stenosis (n = 90) or occlusion of the proximal subclavian artery (84 left-sided). Forty one patients (37%) had symptoms of vertebrobasilar insufficiency, 29 patients (26%) had disabling chronic arm ischemia, and 20 patients had both symptoms. Twenty patients with coronary artery disease underwent PTA in preparation for myocardial revascularization with the internal mammary artery. Duplex scans and arteriograms confirmed significant stenosis or occlusion. All PTA procedures were performed with the patient under local anesthesia, through the femoral artery (n 89), brachial artery (n = 6), or combined route (n = 15). In 59 patients (58%) an additional stent was placed.Results. Angioplasty was initially technically and clinically successful in 102 patients (93%). Seven occlusions could not be recanalized, and 1 procedure had to be stopped because of ischemic stroke. Of the 102 patients in whom treatment was successful, 1 patient (1%) had a minor stroke in the contralateral hemisphere 2 hours post-PTA. Seven patients (7%) had minor problems, all without permanent sequelae. Follow-up with duplex scanning ranged from 3 months to 10 years (mean, 34 months). Primary clinical patency at 5 years was 89%, with a median recurrent obstruction-free period of 23 months. The local complication rate was 4.5%, and the combined stroke and death rate was 3.6%. Significant recurrent obstruction (>70%) developed in 8 patients with clinical symptoms. Four stenoses were successfully treated with repeat PTA (2 with additional stent placement); 4occlusions required surgery.Conclusions. PTA of obstructive lesions of the proximal subclavian artery is not only an effective initial treatment, but is also successful over the long-term. Inasmuch as all clinical failures occured within 26 months after initial therapy, we recommend regular follow-up for at least 2 years post-PTA. All clinically significant recurrent stenoses can be treated with repeat endovascular procedures. We could not prove positive or negative influence of additional placement of stents; however, the number of recurrent stenoses might be too small in this retrospective study to draw firm conclusions. Adverse events of any kind are certainly no greater than with invasive surgical procedures. Therefore PTA must be seriously considered in patients with localized obstruction of the proximal subclavian artery.