Bower T C, Pairolero P C, Hallett J W, Toomey B J, Gloviczki P, Cherry K J
Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Ann Vasc Surg. 1991 Mar;5(2):125-32. doi: 10.1007/BF02016744.
Over a 40 year period (1950-1990) only 73 patients were treated surgically for brachiocephalic aneurysms. An operation was performed for 38 subclavian, 25 extracranial carotid, six innominate, three aberrant right subclavian, and one vertebral artery aneurysm. Twenty-three other associated aneurysms occurred in 14 patients. Five patients had an additional untreated brachiocephalic aneurysm, and nine patients had 18 aneurysms located in different anatomic regions. There were 40 men and 33 women with a mean age of 50.5 years (range 16 to 82 years). Forty patients (54.8%) presented with potentially life- or limb-threatening signs or symptoms, including stroke or transient ischemic attacks (31.5%), upper extremity ischemia (19.2%), and rupture (4.1%). Atherosclerosis was most common in innominate aneurysms (66.7%) but also occurred in subclavian (34.1%) and carotid aneurysms (12.0%). Thoracic outlet compression was a common etiology for subclavian aneurysms while trauma or spontaneous dissection was more frequent for carotid aneurysms. Six deaths (8.2%) occurred within 30 days of operation: two from rupture, three in association with concomitant cardiovascular operations, and one from emergency carotid ligation. There were no deaths with elective isolated surgical repair. Overall five and 10 year survival in patients with brachiocephalic aneurysms was 80.8% and 61.4%, respectively. The majority of brachiocephalic aneurysms present with life- or limb-threatening complications and are associated with a high mortality for emergency or concomitant repair. Early elective isolated surgical repair remains the optimal therapy.
在40年期间（1950 - 1990年），仅73例患者接受了头臂动脉瘤的外科治疗。其中，38例为锁骨下动脉瘤，25例为颅外颈动脉动脉瘤，6例为无名动脉瘤，3例为异常右锁骨下动脉瘤，1例为椎动脉动脉瘤。另外，14例患者还出现了23处其他相关动脉瘤。5例患者有额外未治疗的头臂动脉瘤，9例患者有18处位于不同解剖区域的动脉瘤。患者中男性40例，女性33例，平均年龄50.5岁（范围16至82岁）。40例患者（54.8%）出现了可能危及生命或肢体的体征或症状，包括中风或短暂性脑缺血发作（31.5%）、上肢缺血（19.2%）和破裂（4.1%）。动脉粥样硬化在无名动脉瘤中最为常见（66.7%），但在锁骨下动脉瘤（34.1%）和颈动脉动脉瘤（12.0%）中也有发生。胸廓出口受压是锁骨下动脉瘤的常见病因，而创伤或自发性夹层分离在颈动脉动脉瘤中更为常见。6例患者（8.2%）在术后30天内死亡：2例死于破裂，3例与同期心血管手术相关，1例死于紧急颈动脉结扎。择期单纯手术修复无死亡病例。总体而言，头臂动脉瘤患者的5年和10年生存率分别为80.8%和61.4%。大多数头臂动脉瘤伴有危及生命或肢体的并发症，紧急或同期修复的死亡率很高。早期择期单纯手术修复仍然是最佳治疗方法。
