Abou-Zamzam A M, Moneta G L, Edwards J M, Yeager R A, McConnell D B, Taylor L M, Porter J M
Department of Surgery, Oregon Health Sciences University, Portland Veterans Affairs Medical Center, 97201, USA.
Arch Surg. 1999 Sep;134(9):952-6; discussion 956-7. doi: 10.1001/archsurg.134.9.952.
Extrathoracic cervical grafts are safe and provide long-lasting stroke prevention in patients with disease not amenable to standard carotid bifurcation endarterectomy.
Review of a prospectively maintained vascular surgical registry.
Combined university and Department of Veterans Affairs vascular surgical service.
Patients requiring surgery for carotid atherosclerotic occlusive disease not amenable to endarterectomy from January 1988 to March 1998.
Carotid interposition grafting, subclavian-carotid bypass, or carotid-carotid bypass.
Perioperative stroke and death, and life-table determination of freedom from stroke, stroke-free survival, and graft patency.
Sixty patients (mean age, 65.8 years; range, 36-83) underwent cervically based carotid grafting. All had greater than 70% stenosis or occlusion of the innominate, common carotid, or internal carotid arteries, and 30 (50%) had undergone at least 1 previous ipsilateral carotid endarterectomy. Indication for operation was stroke or transient ischemic attack in 46 (77%) and asymptomatic high-grade stenosis in 14 (23%). Operative procedures included 31 (52%) carotid interposition grafts, 18 (30%) subclavian-carotid grafts, and 11 (18%) carotid-carotid grafts. Mean follow-up was 29 months (range, 1-117 months). Perioperative stroke rate was 5% (3/60) all in symptomatic patients, and there were no perioperative deaths. By life-table analysis, freedom from stroke was 92% at 1 and 5 years. Stroke-free survival was 90% at 1 year and 61% at 5 years. Primary graft patency was 94% at 1 year and 84% at 5 years, with assisted primary patency of 90% at 5 years.
Cervical carotid artery grafts for complicated or recurrent carotid atherosclerosis not amenable to endarterectomy are durable and provide excellent freedom from stroke with low perioperative morbidity and mortality.
对于患有不适于标准颈动脉分叉内膜切除术疾病的患者，胸外颈部移植物是安全的，并且能提供持久的中风预防效果。
回顾前瞻性维护的血管外科登记资料。
大学与退伍军人事务部联合血管外科服务机构。
1988年1月至1998年3月期间因颈动脉粥样硬化闭塞性疾病需要手术且不适于内膜切除术的患者。
颈动脉间置移植术、锁骨下-颈动脉旁路移植术或颈动脉-颈动脉旁路移植术。
围手术期中风和死亡情况，以及通过生命表确定的无中风情况、无中风生存率和移植物通畅率。
60例患者（平均年龄65.8岁；范围36 - 83岁）接受了颈部颈动脉移植术。所有患者无名动脉、颈总动脉或颈内动脉狭窄或闭塞均超过70%，30例（50%）患者此前至少同侧接受过1次颈动脉内膜切除术。手术指征为中风或短暂性脑缺血发作46例（77%），无症状重度狭窄14例（23%）。手术方式包括31例（52%）颈动脉间置移植术、18例（30%）锁骨下-颈动脉移植术和11例（18%）颈动脉-颈动脉移植术。平均随访29个月（范围1 - 117个月）。围手术期中风发生率为5%（3/60），均为有症状患者，无围手术期死亡。通过生命表分析，1年和5年时无中风率分别为92%。1年时无中风生存率为90%，5年时为61%。原发性移植物1年通畅率为94%，5年时为84%，5年时辅助原发性通畅率为90%。
对于不适于内膜切除术的复杂或复发性颈动脉粥样硬化患者，颈部颈动脉移植术效果持久，能显著预防中风，围手术期发病率和死亡率低。
