Ziomek S, Quiñones-Baldrich W J, Busuttil R W, Baker J D, Machleder H I, Moore W S
J Vasc Surg. 1986 Jan;3(1):140-5.
From May 1964 to June 1983, 36 carotid-subclavian bypasses were done in 36 patients who had symptomatic lesions at the origin of the common carotid and/or subclavian arteries at the Center for Health Sciences of the University of California, Los Angeles. Ages ranged from 28 to 82 years (mean, 58 years). Eighteen bypasses were done with prosthetic grafts, 13 done with autogenous vein, and five were transpositions with primary anastomosis of the subclavian and carotid arteries. Follow-up was available on all patients and ranged from 9 to 156 months (mean, 51.5 months). The graft patency rate at 5 years determined by actuarial methods and documented by clinical examination, noninvasive evaluation, and/or arteriography was 94.1% for prosthetic grafts and 58.3% for vein grafts (p less than 0.01). The 5-year cerebrovascular accident (CVA) rate for patients with carotid-subclavian bypass done with prosthetic grafts was 6% in contrast to 39% for those with vein grafts (p less than 0.0545). All reconstructions done by transposition and primary anastomosis remain patent and there have been no late CVAs. We conclude that prosthetic grafts are the arterial substitute of choice in carotid-subclavian bypass. Transposition and primary anastomosis between the carotid and subclavian artery, when technically feasible, may be preferable to the use of free grafts in carotid-subclavian reconstruction.
1964年5月至1983年6月，在洛杉矶加利福尼亚大学健康科学中心，对36例颈总动脉和/或锁骨下动脉起始处有症状性病变的患者进行了36次颈动脉-锁骨下动脉搭桥手术。患者年龄在28岁至82岁之间（平均58岁）。18例使用人工血管进行搭桥，13例使用自体静脉，5例为锁骨下动脉与颈动脉直接吻合的血管移位术。所有患者均获得随访，随访时间为9至156个月（平均51.5个月）。通过精算方法确定，并经临床检查、无创评估和/或血管造影记录，人工血管5年通畅率为94.1%，静脉血管为58.3%（p<0.01）。人工血管搭桥的颈动脉-锁骨下动脉旁路手术患者5年脑血管意外（CVA）发生率为6%，而静脉血管搭桥患者为39%（p<0.0545）。所有通过血管移位和直接吻合完成的重建均保持通畅，且无晚期CVA发生。我们得出结论，人工血管是颈动脉-锁骨下动脉搭桥的首选动脉替代物。在技术可行的情况下，颈动脉与锁骨下动脉之间的血管移位和直接吻合可能比在颈动脉-锁骨下动脉重建中使用游离移植物更可取。
