血管成形术和Stent放置术放射治疗后动脉损伤的治疗

用于评价经皮穿刺血管成形术和Ｓｔｅｎｔ在放疗后所致动脉疾病的治疗，及靶血管内Ｓｔｅｎｔ的长期支撑开放作用。资料和方法：１４例患者，因为放疗所致１８处动脉性病变，而给予血管成形术治疗。１３个Ｓｔｅｎｔ放置于８个患者，分别治疗血管闭塞３例，内膜撕裂１例，动脉瘤１例，残存狭窄２例，多发狭窄１例，球囊成形术后再发狭窄１例。所有病例均用ＣＴ扫描和／或多普勒超声检查，观察Ｓｔｅｎｔ及其靶血管内和Ｓｔｅｎｔ内的血流情况。结果：血管成形术成功治疗１４例病人，８例患者在动脉病变处放置Ｓｔｅｎｔ。１１例动脉病基本消失，追踪２年（８月～５年），临床症状完全解除，３例临床症改善。１１例患者接受了１或２次血管成形术。１例患者重复承受了４次血管成形术，并放置３个Ｓｔｅｎｔ，２个Ｓｔｅｎｔ放在两髂总动脉和腹主动脉，１个Ｓｔｅｎｔ放在腹腔动脉。另１位重复４次血管成形术的患者，在肠系膜上动脉放了２个Ｓｔｅｎｔ。最后１例，因为血管成形术后内膜撕裂和血管闭塞，而放置了１个Ｓｔｅｎｔ，经５年随防，其动脉病变为临床治愈。结论：单一的血管成形术或者多技术综合运用，可有效治疗放疗所致的动脉性病变，应考虑其为动脉损伤性病变的首选治疗

Angioplasty and Stent Placement in Arterial Injury after Radiotherapy

Objective:To evaluate percutaneous transluminal angioplasty and stenting in the treatment of radiation-induced arterial disease and long-term patency of a STENT in the target artery. Material and methods:Percutaneous transluminal angioplasty (PTA) was attempted on 18 arterial lesions following irradiation in 14 patients. Thirteen stents were placed in 8 patients to treat occlusion ( n =3),dissection ( n =1), aneurysm ( n =1), residual stenosis ( n =2), multiple stenoses ( n =1), and delayed restenosis after previous balloon angioplasty ( n =1). The prostheses were readily visualized and the bloodstream within the STENT and the target artery was determined with Doppler US and/or CT scanner in all patients.Results:PTA was technically successful in 14 patients of which 8 underwent STENT placement for their arterial lesions. Eleven of these patients demonstrated primary patency with relief of clinical symptoms with a mean follow-up of 2 years (range, 8 months-5 years). Clinical improvement was noted for the other patients. Eleven patients underwent PTA 1 or 2 times. One patient has undergone PTA 4 times and 3 stents were installed, 2 of which were in the area of the bilateral common iliac-aorta, and 1 in the celiac trunk. Another patient has also undergone PTA 4 times and 2 stents were placed in the superior mesenteric artery. The last patient benefited STENT placement for dissection and occlusion after balloon angioplasty and his arterial lesion was considered to be cured clinically after a follow-up of five years. Conclusion:Our results suggest that PTA with single or multiple techniques may be effective immediately in arterial lesions caused by radiation and can be considered the first therapeutic option in these cases.