椎动脉远端重建：长期疗效

Distal vertebral artery reconstruction: long-term outcome.

作者信息

Kieffer Edouard, Praquin Barbara, Chiche Laurent, Koskas Fabien, Bahnini Amine

机构信息

Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France.

出版信息

J Vasc Surg. 2002 Sep;36(3):549-54. doi: 10.1067/mva.2002.126092.

DOI:10.1067/mva.2002.126092

PMID:12218980

Abstract

PURPOSE

The purpose of this article was to report our long-term results of distal vertebral artery (DVA) reconstruction.

METHOD

From 1978 to 2001 we performed 352 DVA reconstructions on 323 patients (177 men, 148 women; mean age, 60.0 +/- 12.1 years). Symptoms of vertebrobasilar insufficiency were present in 332 cases (94.3%). Bypass grafting using mostly saphenous vein graft was performed in 240 cases (68.2%). In 102 cases (29.0%) the DVA was transposed into the internal carotid artery (ICA). Other techniques were used in 10 cases.

RESULTS

Stroke caused all 7 deaths (2.0%) in the early postoperative period. There were 5 nonfatal strokes (1.4%). Strokes were hemispheric in 7 cases (6 ipsilateral, 1 contralateral) and vertebrobasilar in 5 cases. There were 6 strokes (2.3%) in the subgroup of 264 isolated DVA reconstruction and 6 strokes (6.8%) in the subgroup of 88 procedures involving combined ICA and DVA reconstruction (P <.04). Temporary paralysis of the spinal accessory nerve occurred in 26 cases (7.4%). Intraoperative or early postoperative angiography findings were available in 341 of 345 cases (98.8%). Early postoperative occlusion occurred after 25 procedures (7.1%). Complete clinical follow-up was available for 313 (99.1%) of the postoperative survivors. Mean duration of follow-up was 99.5 +/- 62.5 months. Assessment of late patency was performed in 343 (99.4%) of 345 cases by angiography (21.2%) or duplex scanning (78.8%). A total of 65 (23.7%) patients died during follow-up. No deaths resulted from vertebrobasilar or hemispheric stroke. Cumulative Kaplan-Meier survival rate was 89.0% +/- 3.9% at 5 years and 75.4% +/- 7.1% at 10 years. Significant vertebrobasilar symptom-free rate was 94.0% +/- 3.5% at 5 years and 92.8% +/- 3.8% at 10 years. Primary patency rate was 89.3% +/- 3.6% at 5 years and 88.1% +/- 4.0% at 10 years.

CONCLUSIONS

This study clearly establishes the excellent long-term results of DVA reconstruction for the treatment of extracranial lesions of the vertebral artery. However, every effort should be made to reduce the rate of early postoperative occlusions. The subgroup of patients involving combined ICA and DVA reconstruction remains at high risk of postoperative stroke.

摘要

目的

本文旨在报告我们对椎动脉远端（DVA）重建的长期结果。

方法

1978年至2001年，我们对323例患者（177例男性，148例女性；平均年龄60.0±12.1岁）进行了352次DVA重建。332例（94.3%）存在椎基底动脉供血不足症状。240例（68.2%）主要采用大隐静脉移植进行旁路移植术。102例（29.0%）将DVA转位至颈内动脉（ICA）。10例采用了其他技术。

结果

术后早期7例（2.0%）死亡均由卒中所致。有5例非致命性卒中（1.4%）。7例卒中为半球性（6例同侧，1例对侧），5例为椎基底动脉性。在264例单纯DVA重建亚组中有6例卒中（2.3%），在88例涉及ICA和DVA联合重建手术的亚组中有6例卒中（6.8%）（P<0.04）。26例（7.4%）出现副神经暂时性麻痹。345例中有341例（98.8%）有术中或术后早期血管造影结果。25例手术（7.1%）术后早期出现闭塞。术后幸存者中有313例（99.1%）获得了完整的临床随访。平均随访时间为99.5±62.5个月。345例中的343例（99.4%）通过血管造影（21.2%）或双功超声扫描（78.8%）进行了晚期通畅性评估。随访期间共有65例（23.7%）患者死亡。无死亡由椎基底动脉或半球性卒中导致。5年时累积Kaplan-Meier生存率为89.0%±3.9%，10年时为75.4%±7.1%。5年时显著的无椎基底动脉症状率为94.0%±3.5%，10年时为92.8%±3.8%。5年时原发性通畅率为89.3%±3.6%，10年时为88.1%±4.0%。