Archie J P
Wake Medical Center and Carolina Cardiovascular Associates, Raleigh, NC27610, USA.
J Vasc Surg. 1999 Dec;30(6):1106-12. doi: 10.1016/s0741-5214(99)70050-9.
Revascularization of the internal or external carotid arteries is occasionally indicated for symptomatic atherosclerotic common carotid artery occlusion or long-segment high-grade stenosis beginning at its origin. I report the outcome of axillary artery-based bypass grafts to the distal common, internal, or external carotid arteries.
Between 1981 and 1997, 29 axillary-to-carotid bypass grafting procedures were performed on 28 patients, 15 men and 13 women, with a mean age of 68 years. Indications were transient ischemia in nine patients, amaurosis fugax in four patients, completed stroke in six patients, and nonlateralizing global ischemia in nine patients. Twenty-three common carotid arteries were totally occluded, and six had long-segment stenosis of 90% or greater beginning at the origin. Saphenous vein grafts were used in 25 procedures, and synthetic grafts were used in four. Grafts were placed to 13 internal, eight distal common, and eight external carotid arteries.
There were no perioperative deaths; one stroke occurred (3.4%). No lymphatic or peripheral nerve complications occurred. In a 1- to 11-year follow-up period (mean, 4.5 years), there were no graft occlusions, one restenosis of 50% or greater, and two restenoses of 70% or greater. The 1-year stenosis-free rate for 50% or greater stenosis was 93%, and the 5- and 10-year rates were 87%. No late ipsilateral strokes occurred. The 5- and 10-year survival rates were 64% and 28%, respectively. Coronary artery disease was the major cause of late mortality.
Axillary-to-carotid bypass grafting for severe symptomatic common carotid occlusive disease is safe, well tolerated, durable, and effective in stroke prevention. There is a high late mortality rate because of coronary artery disease in patients with severe proximal common carotid occlusive disease.
对于有症状的动脉粥样硬化性颈总动脉闭塞或起源处的长节段重度狭窄，有时需要进行颈内动脉或颈外动脉血运重建。我报告了基于腋动脉的旁路移植术至颈总动脉远端、颈内动脉或颈外动脉的结果。
1981年至1997年间，对28例患者进行了29例腋-颈动脉旁路移植手术，其中男性15例，女性13例，平均年龄68岁。适应证包括9例患者的短暂性脑缺血发作、4例患者的一过性黑矇、6例患者的完全性卒中以及9例患者的非定位性全脑缺血。23条颈总动脉完全闭塞，6条在起源处有90%或更高的长节段狭窄。25例手术使用了大隐静脉移植物，4例使用了人工血管移植物。移植物分别植入13条颈内动脉、8条颈总动脉远端和8条颈外动脉。
围手术期无死亡；发生1例卒中（3.4%）。未发生淋巴或周围神经并发症。在1至11年的随访期（平均4.5年）内，无移植物闭塞，1例再狭窄达50%或更高，2例再狭窄达70%或更高。50%或更高狭窄的1年无狭窄率为93%，5年和10年率为87%。未发生晚期同侧卒中。5年和10年生存率分别为64%和28%。冠状动脉疾病是晚期死亡的主要原因。
对于严重有症状的颈总动脉闭塞性疾病，腋-颈动脉旁路移植术安全、耐受性好、持久且在预防卒中方面有效。严重近端颈总动脉闭塞性疾病患者因冠状动脉疾病导致晚期死亡率较高。
