Rosseĭkin E V, Voevodin A B, Radzhabov D A, Bazylev V V
Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia.
Angiol Sosud Khir. 2017;23(1):104-110.
Acute and chronic cerebral circulatory impairment is a very commonly encountered type of neurological diseases, annually affecting more than six million people worldwide. The absolute majority of all cases are associated with atherosclerosis of cerebral arteries. Surgical intervention in a stenotic lesion of the internal carotid artery (ICA) is a method of preventive treatment with confirmed efficacy. Eversion carotid endarterectomy (ECEA) is currently the most commonly used 'open' operation for this cohort of patients. It is connected with relative technical simplicity of the operative procedure, no foreign material in the wound, low risk of haemodynamic disorders in the zone of reconstruction owing to no considerable alteration in the ICA diameter, as well as favourable remote results. A disadvantage of ECEA is lack of visual control above the distal portion of the ICA and, as a consequence, limited application of the technique in cases of a highly located atherosclerotic plaque (by more than 2 cm above the bifurcation). Specialists of the Federal Centre of Cardiovascular Surgery in the city of Penza worked out a modification of the operative technique making it possible to widen the indications for using ECEA. Its essence consists in total resection of the stenosed portion of the ICA, performing eversion endarterectomy outside the wound, followed by reimplantation thereof with the help of two 'end-to-end' anastomoses, as during prosthetic repair. This technique was called autotransplantation of the ICA. Advantages of this technique are considered to include precision of removing the plaque and intimal ruptured fragments, which is easier and more convenient to achieve outside the wound; reliable fixation of the intima and non-stenosing residuals of the plaque by a distal anastomosis, as well as a possibility of using this technique in cases of high location of the plaque. The purpose of this study was to compare the immediate results_outcomes of ECEA and autotransplantation of the ICA in two groups comprising 108 and 72 patients, respectively. The measures assessed included the mean time of ICA cross-clamping during surgery, frequency of the development of perioperative strokes, haemorrhage, lesions of craniocerebral nerves, wound complications.
急性和慢性脑循环障碍是一种非常常见的神经疾病类型，全球每年有超过600万人受其影响。所有病例中的绝大多数都与脑动脉粥样硬化有关。对颈内动脉（ICA）狭窄病变进行手术干预是一种已证实有效的预防性治疗方法。外翻颈动脉内膜切除术（ECEA）是目前针对这类患者最常用的“开放性”手术。它与手术操作相对简单、伤口无异物、由于ICA直径无明显改变重建区域血流动力学紊乱风险低以及远期效果良好有关。ECEA的一个缺点是在ICA远端部分上方缺乏视觉控制，因此，在高位动脉粥样硬化斑块（分叉上方超过2厘米）的情况下该技术的应用有限。奔萨市联邦心血管外科中心的专家们对手术技术进行了改进，使得扩大ECEA的应用指征成为可能。其本质在于完全切除ICA的狭窄部分，在伤口外进行外翻内膜切除术，然后借助两个“端端”吻合术将其重新植入，就像在假体修复过程中一样。这种技术被称为ICA自体移植。该技术的优点被认为包括清除斑块和内膜破裂碎片的精确性，在伤口外更容易、更方便实现；通过远端吻合可靠地固定内膜和斑块的无狭窄残余部分，以及在斑块高位的情况下使用该技术的可能性。本研究的目的是比较分别由108例和72例患者组成的两组中ECEA和ICA自体移植的近期结果/结局。评估的指标包括手术期间ICA交叉夹闭的平均时间、围手术期中风、出血、颅神经损伤、伤口并发症的发生率。
