Luo Xiao Yun, Wu Qing Hua, Zhang Fu Xian
Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Ann Vasc Surg. 2017 Jul;42:101-110. doi: 10.1016/j.avsg.2017.01.001. Epub 2017 Mar 1.
Severe cerebral ischemia in patients with Takayasu's arteries was caused by occlusion of most supra-aortic arteries. Arterial revascularization is necessary to decrease the incidence of stroke and improve the quality of life but may be complicated with multiple occlusive lesions and inflammation condition of this disease. This study was to assess options and long-term outcomes of surgical and endovascular treatment.
Twenty-nine patients with severe cerebral ischemic symptoms underwent surgical or endovascular treatment from January 1991 to July 2015. Demographic characteristics, surgical and endovascular procedures, and follow-up outcomes were reviewed. Risk factors associated with primary patency of surgical treatment and assisted primary patency of endovascular treatment was identified by Cox regression analyses.
There were 29 patients with a median age of 24 (range 9-37 years), 9 in active and 20 in inactive phase. Seventeen patients underwent a variety of bypass procedures. Fourteen endovascular procedures were performed in 12 patients. No death occurred within 30 days after both procedures. Complications within 30 days after bypass included stroke in 1 patient, infection in 2 patients, and heart failure in 1 patient. Nine patients developed brain hyperperfusion after bypass. Transient hemiplegic paralysis occurred in 1 patient during dilation of the carotid artery. During a median follow-up time of 41 months, primary and secondary patency rate of bypass at 1 and 3 years was 93.75% and 100% and 87.5% and 100%, respectively. Assisted primary and secondary patency rate of endovascular treatment at 1 and 3 years was 85.71% and 92.86% and 68.18% and 75.66%, respectively. There was no independent risk factor associated with either primary patency of surgical treatment or assisted primary patency of endovascular treatment. Disease activity was independent risk factor associated with combined rate of primary patency of surgical treatment and assisted primary patency of endovascular treatment (HR: 0.17, 95% CI: 0.03-0.93, P = 0.04).
Bypass is the preferred treatment in majority of patients with good long-term patency, even has a higher propensity for postoperative complications. Endovascular treatment should be preserved for short lesions in inappropriate or high-risk surgical patients but needs more reintervention and close monitoring of lesion for better outcomes. Long-term patency of surgical and endovascular treatment is related with disease activity. Combination of surgical or endovascular treatment and medical therapy may improve the efficacy of interventions.
大动脉炎患者的严重脑缺血是由多数主动脉弓上动脉闭塞所致。动脉血运重建对于降低卒中发生率和改善生活质量是必要的，但可能因该病的多发闭塞性病变和炎症状态而出现并发症。本研究旨在评估手术和血管内治疗的选择及长期疗效。
1991年1月至2015年7月，29例有严重脑缺血症状的患者接受了手术或血管内治疗。回顾了人口统计学特征、手术和血管内治疗过程以及随访结果。通过Cox回归分析确定与手术治疗的原发性通畅和血管内治疗的辅助原发性通畅相关的危险因素。
29例患者，中位年龄24岁（范围9 - 37岁），9例处于活动期，20例处于非活动期。17例患者接受了各种搭桥手术。12例患者进行了14次血管内治疗。两种治疗后30天内均无死亡发生。搭桥术后30天内的并发症包括1例卒中、2例感染和1例心力衰竭。9例患者搭桥术后发生脑过度灌注。1例患者在颈动脉扩张时出现短暂性偏瘫。中位随访时间41个月，搭桥手术1年和3年的原发性和继发性通畅率分别为93.75%和100%以及87.5%和100%。血管内治疗1年和3年的辅助原发性和继发性通畅率分别为85.71%和92.86%以及68.18%和75.66%。手术治疗的原发性通畅或血管内治疗的辅助原发性通畅均无独立危险因素。疾病活动是与手术治疗的原发性通畅和血管内治疗的辅助原发性通畅合并率相关的独立危险因素（HR：0.17，95%CI：0.03 - 0.93，P = 0.04）。
搭桥是大多数患者的首选治疗方法，长期通畅性良好，即使术后并发症发生率较高。血管内治疗应保留用于不适合手术或手术风险高的患者的短病变，但需要更多的再次干预和对病变的密切监测以获得更好的疗效。手术和血管内治疗长期通畅与疾病活动有关。手术或血管内治疗与药物治疗联合可能提高干预效果。
