Cormier F, Korso F, Fichelle J M, Gautier C, Cormier J M
Clinique Georges Bizet, Paris, France.
J Mal Vasc. 2001 Feb;26(1):45-9.
Post-irradiation axillo-subclavian arteriopathy can develop 6 months to 20 years after radiotherapy. Incidence estimated from duplex scan screening is about 30%, half of the cases having no hemodynamic significance. In our experience, asymptomatic lesions are the most common. Nevertheless, we have observed since 1978, 38 symptomatic patients including 23 with either acute ischemia (8 patients), or chronic ischemia (15 patients) requiring revascularization. We used an endovascular approach in 8 and open surgery in 15. A bypass graft was performed in 13 patients, using a vein (8 patients) rather than a prosthesis (5 patients), implanted in healthy territory, proximally or in the common carotid (11 patients) or the proximal subclavian (2 patients), and distally in the axillary artery (5 patients) or the brachial artery (8 patients). One venous bypass became occluded postoperatively. The other bypasses remained patent during follow-up of over 10 years. There of the five prosthetic bypassess gradually failed without recurrence of critical ischemia. Other revascularization procedures included endarterectomy and thrombectomy. In the long term, functional prognosis mainly depended on the frequently associated involvement of the plexus in the post-irradiation changes, which, together with the revascularization procedure, also required neurolysis in 11 patients, two omental covers and a free musculocutaneous transfer in 9 patients.
放疗后腋-锁骨下动脉病变可在放疗后6个月至20年出现。根据双功扫描筛查估计的发病率约为30%，其中一半病例无血流动力学意义。根据我们的经验，无症状病变最为常见。然而，自1978年以来，我们观察到38例有症状的患者，其中23例患有急性缺血（8例患者）或慢性缺血（15例患者），需要进行血运重建。我们对8例患者采用了血管内治疗方法，对15例患者采用了开放手术。13例患者进行了旁路移植，其中8例使用静脉而非人工血管（5例患者），移植到健康区域，近端位于颈总动脉（11例患者）或近端锁骨下动脉（2例患者），远端位于腋动脉（5例患者）或肱动脉（8例患者）。1例静脉旁路术后闭塞。其他旁路在超过10年的随访中保持通畅。5例人工血管旁路中有3例逐渐失功，但未出现严重缺血复发。其他血运重建手术包括动脉内膜切除术和血栓切除术。从长期来看，功能预后主要取决于放疗后改变中常见的臂丛神经受累情况，这与血运重建手术一起，还需要对11例患者进行神经松解，对9例患者进行两次网膜覆盖和一次游离肌皮瓣移植。
