Huilgol Ravi L, Young Jane, Lemech Lubomyr, Stephen Michael S, May James, Harris John P, White Geoffrey H
Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2006 Oct;76(10):878-81. doi: 10.1111/j.1445-2197.2006.03830.x.
Bypass for extra-cranial arterial disease is infrequently carried out. We reviewed our experience to determine the outcome of carotid artery grafting using either an autogenous vein or polytetrafluoroethylene (PTFE).
Details of patients were recorded prospectively as part of a vascular surgical registry. Patients identified from the registry as having carotid artery bypass procedures were classified according to the type of conduit used. Comparison was made between patients with autogenous vein and PTFE grafts.
Between 1978 and 2002, 24 patients (13 men and 11 women) mean age 60.0 +/- 13.4 years (range, 20-81 years) underwent 28 bypass procedures (three were bilateral and one was a reoperation). Symptomatic carotid disease was the clinical indication in 20 of 28 procedures (71.4%). Pathological indications included advanced atherosclerosis of the carotid arteries (15), past radiotherapy (4), failed stenting (3), resection of carotid body tumour (2), trauma (1), reoperation on a failed graft (1), carotid aneurysm (1) and iatrogenic carotid occlusion (1). An autogenous vein was used in 16, PTFE in 11 and autogenous artery in 1 of the patients. Using the Kaplan-Meier method, the overall patient cumulative 5-year survival was 84% and cumulative 5-year stroke-free survival was 93%. The combined perioperative stroke and mortality rate was 7.1%. Two patients had transient ischaemic attacks (7.1%), one had cranial nerve palsies (3.6%) and one required reoperation for bleeding (3.6%). Five-year cumulative graft primary patency using the Kaplan-Meier method was 74% for PTFE grafts and 92% for autogenous vein grafts (P = 0.37).
Carotid artery bypass is a safe and a useful treatment option for complex extra-cranial arterial disease. Either PTFE or autogenous veins may be used as conduits.
颅外动脉疾病的旁路手术很少进行。我们回顾了我们的经验，以确定使用自体静脉或聚四氟乙烯（PTFE）进行颈动脉移植的结果。
作为血管外科登记的一部分，前瞻性记录患者的详细信息。从登记处确定接受颈动脉旁路手术的患者根据所用导管类型进行分类。对使用自体静脉和PTFE移植物的患者进行比较。
1978年至2002年期间，24例患者（13例男性和11例女性），平均年龄60.0±13.4岁（范围20 - 81岁）接受了28次旁路手术（3例为双侧手术，1例为再次手术）。28例手术中有20例（71.4%）的临床指征为有症状的颈动脉疾病。病理指征包括颈动脉晚期动脉粥样硬化（15例）、既往放疗（4例）、支架置入失败（3例）、颈动脉体瘤切除（2例）、创伤（1例）、移植失败后的再次手术（1例）、颈动脉动脉瘤（1例）和医源性颈动脉闭塞（1例）。16例患者使用自体静脉，11例使用PTFE，1例使用自体动脉。采用Kaplan-Meier法，患者总体5年累积生存率为84%，5年无卒中累积生存率为93%。围手术期卒中与死亡率合并为7.1%。2例患者发生短暂性脑缺血发作（7.1%），1例出现颅神经麻痹（3.6%），1例因出血需要再次手术（3.6%）。采用Kaplan-Meier法，PTFE移植物的5年累积移植原发性通畅率为74%，自体静脉移植物为92%（P = 0.37）。
颈动脉旁路手术是治疗复杂颅外动脉疾病的一种安全且有用的选择。PTFE或自体静脉均可作为导管使用。
