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大动脉炎患者的主动脉-颈动脉搭桥术。

Aorto-carotid bypass in patients with Takayasu arteritis.

作者信息

Han Hong Seok, Yoon Kyoung Won, Heo Seon-Hee, Park Yang Jin, Kim Young-Wook, Kim Dong-Ik

机构信息

Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Ann Surg Treat Res. 2017 Sep;93(3):143-151. doi: 10.4174/astr.2017.93.3.143. Epub 2017 Aug 30.

DOI:10.4174/astr.2017.93.3.143
PMID:28932730
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5597538/
Abstract

PURPOSE

Takayasu arteritis is an indication for bypass surgery when this condition results in severe cerebrovascular ischemia due to occlusion of the carotid arteries. We reviewed the patients with Takayasu arteritis who received aorto-carotid bypass due to cerebrovascular ischemia.

METHODS

A retrospective review was performed on 19 patients with Takayasu arteritis who underwent aorto-carotid bypass from March 2002 to April 2015.

RESULTS

All patients were female and the mean of their age was 40.6 ± 15.3 years. Eleven patients (57.9%) underwent aorto-uni-carotid bypass and 8 patients (42.1%) underwent aorto-bi-carotid bypass. Five patients (26.3%) whose postoperative blood pressure was not controlled suffered an intracranial hemorrhage within 8 days after bypass surgery. Of the patients with an intracranial hemorrhage, 2 patients (10.5%) expired on 26 days and 7 years after surgery, and 3 patients (15.8%) resolved spontaneously. One patient (5.3%) expired due to an intracranial infarction 9 years after bypass surgery. The intracranial ischemic symptoms resolved after bypass surgery in all of the surviving patients. None of the patients experienced anastomosis site complication postoperatively.

CONCLUSION

Aorto-carotid bypass is effective for treating Takayasu arteritis with cerebrovascular ischemia, and the results suggest that postoperative blood pressure should be strictly managed to prevent intracranial hemorrhage.

摘要

目的

当大动脉炎导致颈动脉闭塞引起严重脑血管缺血时，是旁路手术的适应证。我们回顾了因脑血管缺血接受主动脉-颈动脉旁路手术的大动脉炎患者。

方法

对2002年3月至2015年4月期间接受主动脉-颈动脉旁路手术的19例大动脉炎患者进行回顾性研究。

结果

所有患者均为女性，平均年龄为40.6±15.3岁。11例患者（57.9%）接受了主动脉-单侧颈动脉旁路手术，8例患者（42.1%）接受了主动脉-双侧颈动脉旁路手术。5例（26.3%）术后血压未得到控制的患者在旁路手术后8天内发生颅内出血。在颅内出血患者中，2例（10.5%）分别在术后26天和7年死亡，3例（15.8%）颅内出血自发缓解。1例（5.3%）患者在旁路手术后9年因颅内梗死死亡。所有存活患者的颅内缺血症状在旁路手术后均得到缓解。术后无一例患者发生吻合口部位并发症。

结论

主动脉-颈动脉旁路手术对治疗伴有脑血管缺血的大动脉炎有效，结果表明应严格控制术后血压以预防颅内出血。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/0d6a87f3eb58/astr-93-143-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/319fe2836bf4/astr-93-143-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/c429f14aecda/astr-93-143-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/5c4d149f7c62/astr-93-143-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/bc524af8402e/astr-93-143-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/90c11bae5515/astr-93-143-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/3589d134bd55/astr-93-143-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/0d6a87f3eb58/astr-93-143-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/319fe2836bf4/astr-93-143-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/c429f14aecda/astr-93-143-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/5c4d149f7c62/astr-93-143-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/bc524af8402e/astr-93-143-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/90c11bae5515/astr-93-143-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/3589d134bd55/astr-93-143-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979b/5597538/0d6a87f3eb58/astr-93-143-g007.jpg

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