The Vascular Group, Albany Medical College, Albany Medical Center Hospital, Albany, NY.
The Vascular Group, Albany Medical College, Albany Medical Center Hospital, Albany, NY.
J Vasc Surg. 2019 Dec;70(6):1935-1941. doi: 10.1016/j.jvs.2019.01.070. Epub 2019 Jul 18.
Ipsilateral internal carotid artery bypass has been used successfully to treat aneurysms, infection, tumor, and occlusive disease. The purpose of this study was to evaluate the long-term outcomes of autogenous and prosthetic conduits used for ipsilateral internal carotid artery bypass.
A retrospective review of a single-institution registry was performed to identify patients with ipsilateral carotid artery bypass. Demographics, complications, and patency were recorded and compared using χ, Fisher's exact, and log-rank analysis.
From 1994 to 2016, 105 patients underwent ipsilateral carotid artery bypass (86 prosthetic, 19 veins). The venous bypass group and prosthetic bypass group were different in terms of gender (8 males and 11 females vs 58 males and 28 females; P = .038), but similar in age (mean in the venous bypass group, 63 years [range, 18-80 years] vs mean in the prosthetic bypass group 68 years [range, 33-88 years], P = .052). The mean follow-up was 53 months (range, 1 month to 15 years). Diabetes, pulmonary disease, hypercholesterolemia, and tobacco use were not statistically different between the groups. Indications were different between the groups, with a prosthetic bypass being used more often for occlusive disease and a venous bypass used more often for infection, aneurysm, trauma, and tumor (Fisher's exact test, P = .004). Perioperative complications were few and similar between groups (restenosis, immediate occlusion, and neurologic morbidity). Patency rates, as determined by duplex ultrasound examination, were similar at 1 year (100% venous bypass group vs 99% prosthetic bypass group; P = .434). The 10-year follow-up with an estimated patency based on extrapolated survival curves to be 84% for the venous bypass group vs 88% for the prosthetic bypass group.
Ipsilateral internal carotid artery bypass performed for a variety of indications using prosthetic and venous conduits have demonstrated excellent short-term results. Both types of conduits in this series have trended toward continued durability over long-term follow-up.
同侧颈内动脉旁路移植术已成功用于治疗动脉瘤、感染、肿瘤和闭塞性疾病。本研究旨在评估用于同侧颈内动脉旁路移植术的自体和人工移植物的长期结果。
对单机构注册中心进行回顾性分析，以确定同侧颈内动脉旁路移植术患者。记录人口统计学、并发症和通畅性，并使用卡方检验、Fisher 确切检验和对数秩检验进行比较。
1994 年至 2016 年，105 例患者接受了同侧颈内动脉旁路移植术（86 例采用人工移植物，19 例采用静脉）。静脉旁路组和人工移植物组在性别方面存在差异（8 名男性和 11 名女性与 58 名男性和 28 名女性；P=0.038），但在年龄方面相似（静脉旁路组的平均年龄为 63 岁[范围，18-80 岁]，人工移植物组的平均年龄为 68 岁[范围，33-88 岁]，P=0.052）。平均随访时间为 53 个月（范围，1 个月至 15 年）。两组之间糖尿病、肺部疾病、高胆固醇血症和吸烟史无统计学差异。两组的适应证不同，人工移植物组更常用于闭塞性疾病，静脉旁路组更常用于感染、动脉瘤、创伤和肿瘤（Fisher 确切检验，P=0.004）。围手术期并发症少且两组相似（再狭窄、即刻闭塞和神经功能障碍）。通过双功能超声检查确定的通畅率在 1 年时相似（静脉旁路组为 100%，人工移植物组为 99%；P=0.434）。10 年随访时，根据外推生存曲线估计的通畅率，静脉旁路组为 84%，人工移植物组为 88%。
用于多种适应证的同侧颈内动脉旁路移植术，采用人工和静脉移植物，均取得了优异的短期效果。在本系列中，这两种移植物在长期随访中都呈现出持续耐久性的趋势。
