Bryan A J, Hicks E, Lewis M H
Department of General Surgery, East Glamorgan General Hospital, Church Village, Nr Pontypridd.
Ann R Coll Surg Engl. 1989 Mar;71(2):140-2.
Four cases of unilateral digital ischaemia in the upper limb secondary to embolisation from atheromatous plaques in the proximal subclavian artery are presented. Digital subtraction angiography or arch aortography were used to demonstrate the site of atheroma. In one case diagnostic delay resulted from failure to visualise the site of embolisation on the original aortogram and a repeat examination was necessary. Subclavian endarterectomy was undertaken in each case and irreversibly ischaemic digits were managed by local amputation in two cases. Direct surgery to remove the site of embolisation was preferred to bypass or transposition procedures. No further embolic episodes have been recorded with a follow-up of 6 months to 3 years. The important diagnostic features and options in surgical management of this syndrome are discussed.
本文报告了4例因锁骨下动脉近端动脉粥样硬化斑块栓塞继发上肢单侧手指缺血的病例。采用数字减影血管造影或主动脉弓造影来显示动脉粥样硬化的部位。其中1例因最初的主动脉造影片未能显示栓塞部位而导致诊断延迟，需要再次检查。每例均行锁骨下动脉内膜切除术，2例不可逆缺血手指行局部截肢术。与旁路或转位手术相比，直接手术切除栓塞部位更为可取。随访6个月至3年，未记录到进一步的栓塞事件。本文讨论了该综合征重要的诊断特征及手术治疗选择。
