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目的探讨复杂锁骨下动脉闭塞性病变腔内治疗的特点。方法回顾首都医科大学宣武医院血管外科2012年1月至2013年12月期间治疗的92例复杂锁骨下动脉闭塞性病变患者临床资料,分析患者的病变特点、腔内手术治疗成功率、联合入路应用、术后症状改善等。结果将复杂锁骨下动脉闭塞性病变分为3型:Ⅰ型为左侧锁骨下动脉长段闭塞,Ⅱ型为右侧锁骨下动脉开口处狭窄或闭塞,Ⅲ型为伴有椎动脉开口病变或影响椎动脉开口的锁骨下动脉狭窄或闭塞。本组患者手术成功率为82.6%。27.2%患者选用股动脉和肱动脉联合入路,提高了手术成功率。术后患者症状改善率为81.6%。结论上肢动脉入路能够提高左侧锁骨下动脉长段闭塞的开通率,保证右锁骨下动脉开口处支架的准确定位。锁骨下动脉闭塞性病变腔内手术治疗过程中要注意保护椎动脉。
Objective To explore the characteristics of complex intracavitary treatment of complex subclavian artery occlusive disease. Methods The clinical data of 92 patients with complicated subclavian artery occlusive disease treated in Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University from January 2012 to December 2013 were retrospectively reviewed. The pathological characteristics, success rate of endovascular surgery, combined approach Application, postoperative symptoms such as improvement. The results of complex subclavian artery occlusive lesions were divided into three types: type Ⅰ for the long side of the left subclavian artery occlusion, type Ⅱ for the right subclavian artery stenosis or occlusion, type Ⅲ associated with open or vertebral artery disease or Affect the opening of the subclavian artery stenosis or occlusion. The success rate of this group of patients was 82.6%. 27.2% of patients choose the femoral artery and brachial approach combined to improve the success rate of surgery. Postoperative symptom improvement rate was 81.6%. Conclusion The upper extremity arterial approach can improve the occlusion opening rate of the left subclavian artery and ensure the accurate positioning of the stent at the opening of the right subclavian artery. Subclavian artery occlusive disease in the surgical treatment of intracavitary should pay attention to the protection of the vertebral artery.