AbuRahma A F, Robinson P A, Khan M Z, Khan J H, Boland J P
Department of Surgery, West Virginia University Health Sciences Center, Charleston Area Medical Center.
Surgery. 1992 Jul;112(1):84-91.
Sixty-seven patients who underwent carotid-subclavian bypass (CSBP) (28 CSBPs only and eight with carotid endarterectomy) or axilloaxillary artery bypass (n = 31) with polytetrafluoroethylene grafts were followed up for a mean of 69.2 and 71.9 months, respectively. Indications for surgery in the CSBP group included hemispheric transient ischemic attack (TIA)/cerebrovascular accident in five, nonhemispheric TIA in seven, upper extremity ischemia in 15, and combined TIA and arm ischemia in nine patients. In the axilloaxillary artery group, two patients had hemispheric TIA, five had nonhemispheric TIA, 12 had upper extremity ischemia, and 12 had combined TIA and arm ischemia. Graft patency was determined clinically and confirmed by segmental Doppler pressures, duplex ultrasonography, or angiography. The 30-day mortality rate was approximately 3% in both groups. The 30-day complication rate was 3% for the axilloaxillary artery group and 8% for the CSBP group (not statistically significant). Relief of symptoms was achieved in 100% of patients in both groups; however, 20% of the patients in the axilloaxillary artery group had a recurrence of symptoms, in contrast to 5.6% in the CSBP group. The cumulative 10-year primary and secondary patency rates, calculated by life-table analysis, were 66% and 84.6% for the axilloaxillary artery procedures and 93.8% and 93.8% for the CSBP procedures, respectively (statistically significant). Concomitant carotid endarterectomy with CSBP did not influence graft patency. In conclusion, both bypasses have comparable morbidity and mortality rates; however, the CSBP has a statistically significantly better primary patency rate than the axilloaxillary artery bypass. Therefore CSBP should be the procedure of choice and the axilloaxillary artery bypass should be restricted to high-risk patients.
67例行颈动脉 - 锁骨下动脉搭桥术（CSBP）（仅28例CSBP，8例合并颈动脉内膜切除术）或腋 - 腋动脉搭桥术（n = 31）并使用聚四氟乙烯移植物的患者分别接受了平均69.2个月和71.9个月的随访。CSBP组的手术指征包括5例半球性短暂性脑缺血发作（TIA）/脑血管意外、7例非半球性TIA、15例上肢缺血以及9例合并TIA和手臂缺血。在腋 - 腋动脉组中，2例患者有半球性TIA，5例有非半球性TIA，12例有上肢缺血，12例有合并TIA和手臂缺血。通过临床判定移植物通畅情况，并经节段性多普勒压力、双功超声或血管造影证实。两组的30天死亡率约为3%。腋 - 腋动脉组的30天并发症发生率为3%，CSBP组为8%（无统计学意义）。两组患者症状均得到缓解；然而，腋 - 腋动脉组20%的患者症状复发，而CSBP组为5.6%。通过寿命表分析计算的10年累计原发性和继发性通畅率，腋 - 腋动脉手术分别为66%和84.6%，CSBP手术分别为93.8%和93.8%（有统计学意义）。CSBP联合颈动脉内膜切除术不影响移植物通畅情况。总之，两种搭桥术的发病率和死亡率相当；然而，CSBP的原发性通畅率在统计学上显著优于腋 - 腋动脉搭桥术。因此，CSBP应作为首选术式，腋 - 腋动脉搭桥术应仅限于高危患者。
