|
Treatment of the subclavicle artery obstruction disease via humeral artery puncture
张晓波 金征宇
杨 宁 刘 巍
潘 杰 李晓光
中国医学科学院北京协和医科大学北京协和医院放射科，100730
Xiaopo Zhang, Zhengyu Jin, Ning Yang, Wei Liu, Jie Pan ,Xiaoguang Li
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
ABSTRACT
Objective: To evaluate the clinical effect of brachial artery access for percutaneous transluminal angioplasty(PTA) of proximal subclavian artery occlusions.
Methods: Nine patients with proximal subclavian artery occlusion were treated by PTA via brachial approach. All patients suffered from subclavian steal syndrome or/and brachial syndrome.Six lesions were successfully dilated and stents were implanted in two lesions.
Results: In 8 of 9 patients(88.8%),we passed the occlusion and dilated the artery at the obstruction site. In 1 patients, the occlusion proved too solid to be passed by the guidewire and diagnostic catheter. There were no cerebral complications and death. During the follow-up of 10-41 months(average 28.6 months),there was only 1 restenosis occurred 12 months after PTA. In the 2 patients with stents, no restenosis occurred. Conclusion: The results suggest that brachial artery access for percutaneous transluminal angioplasty(PTA) of proximal subclavian artery occlusions is safe and effective.
key words: Angioplasty; Subclavian artery; Occlusion
自1974年Grutzing 及Hopff[1]完成首例球囊导管血管扩张术以来，此种方法已被广泛应用于治疗因动脉粥样硬化导致的下肢及肾动脉狭窄性疾病。在1980年，Bachman及Kim［2］首次尝试以此种方法治疗锁骨下动脉狭窄。通常锁骨下动脉经皮腔内成形术(PTA)多采用经股动脉穿刺插管的方式进行，然而，当锁骨下动脉完全闭塞时，经股动脉途径常无法使导丝及导管通过病变段血管。本院采用经肱动脉穿刺插管方法治疗9例锁骨下动脉闭塞的病人，效果很好，现介绍如下。
一、材料与方法
1. 临床资料
自1994年2月至2000年8月，对9例锁骨下动脉完全闭塞的患者在经股动脉穿刺插管无法通过病变段血管的情况下，采取经肱动脉途径穿刺插管进行治疗。患者年龄45-72岁(平均年龄63岁)，其中男性6例，女性3例。其诊断依据症状及临床检查。双上肢收缩压测定需相差20mmHg柱以上(DSA)均显示锁骨下动脉闭塞 。2例患者有椎基底动脉供血不足症状，如头晕、晕厥、发作性视力模糊等， 3例患者有上肢缺血症状，4例患者同时有神经学症状及上肢症状。DSA显示病变均位于左锁骨下动脉起始段与椎动脉开口之间。6例患者有锁骨下动脉盗血现象。5例患者不伴有明显的其他动脉疾病，4例患者同时伴有肾动脉、下肢动脉或脑动脉的狭窄或闭塞。确诊为闭塞性动脉粥样硬化4例，大动脉炎4例，原因不明者1例。闭塞段长度0.5-3cm(平均1.8cm)。 | 
