目的：探讨股动脉肱动脉联合入路在锁骨下动脉闭塞性病变腔内治疗中应用的适应证、优势及并发症。方法：回顾首都医科大学宣武医院血管外科2011 年1 月—2014 年6 月采用联合入路进行腔内治疗的57 例锁骨下动脉闭塞性病变患者，分析患者病变特点、手术成功率、联合入路的优势、并发症及随访情况。结果：患者病变可分为3 种类型，包括顺行无法开通的锁骨下动脉闭塞（31 例）；右锁骨下动脉起始部狭窄或闭塞（16 例）；紧邻椎动脉开口的远段锁骨下动脉狭窄或闭塞（10 例）。全组腔内治疗成功率为91.2%，出现穿刺并发症3 例。术后6、12、24、36 个月，支架通畅率分别为100%、100%、90%、77.7%。结论：对于常规入路难以开通的锁骨下动脉闭塞，联合入路能够有效提高开通率，且有利于支架的精准定位减少并发症发生等优势。
Endovascular therapy of subclavian artery occlusion via combined brachial and femoral approach
Objective: To investigate the indications, advantages and complications of using combined brachial and femoral approach for endovascular treatment of subclavian artery occlusion. Methods: Fifty-seven patients with subclavian arterial occlusive disease undergoing endovascular therapy via the combined approach in Department of Vascular Surgery, Xuanwu Hospital of Capital Medical University from January 2011 to June 2014 were reviewed. The pathological characteristics of the patients, success rate of operation, advantages of the combined approach, complications, and follow-up results were analyzed. Results: There was three lesion types among the patients, which included subclavian artery occlusion that failed to be recanalized by anterograde approach (31 cases), the stenosis or occlusion located in the opening of right subclavian artery (16 cases), and the distal subclavian artery stenosis or occlusion adjacent to the opening of the vertebral artery (10 cases). The success rate of endovascular treatment was 91.2% for the entire group, and puncture complications occurred in 3 cases. The stent patency rate at postoperative 6, 12, 24, and 36 months was 100%, 100%, 90% and 77.7%, respectively. Conclusion: For subclavian artery occlusion difficult to be recanalized by conventional approach, the combined approach can effectively improve the recanalization rate, with the advantages of helping to ensure the accuracy of stent positioning and reduce the occurrence of complications.