Rosenthal D, Ellison R G, Clark M D, Lamis P A, Stanton P E, Codner M A, Daniel W W
Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia, Atlanta.
J Cardiovasc Surg (Torino). 1988 Mar-Apr;29(2):191-5.
To evaluate the efficacy and long-term patency results of axilloaxillary bypass, a review of 32 patients with follow-up extending to 11 years was done. Twenty-two bypasses were performed for vertebrobasilar symptoms or subclavian steal and 10 for upper extremity claudication and/or ischemia. The mean age of the operative group was 66 years, 94% of patients had more than one atherosclerotic risk factor (hypertension, diabetes, coronary artery disease, smoking), and 75% had undergone a previous arterial reconstruction operation. There were no operative deaths, and the only postoperative complication was a sterile seroma which responded to aspiration. At late follow-up extending to 11 years, three grafts had thrombosed while another became infected and had to be removed; no limb loss resulted from these graft failures and the actual late patency rate was 87%. Carotid-subclavian bypass, intrathoracic bypasses, and endarterectomy at the site of occlusion have all been suggested for the treatment of symptomatic proximal subclavian artery disease. With axilloaxillary bypass, however, the hazards associated with carotid artery manipulation, operation on the notoriously treacherous subclavian artery, and the morbidity related to thoracotomy in this older, high-risk patient population can be avoided. The axilloaxillary bypass is safe and simple, and the excellent long-term patency rates make it the procedure of choice for symptomatic subclavian artery disease.
为评估腋腋旁路手术的疗效和长期通畅结果，我们对32例患者进行了回顾性研究，随访时间长达11年。其中22例旁路手术用于治疗椎基底动脉症状或锁骨下动脉窃血，10例用于治疗上肢间歇性跛行和/或缺血。手术组的平均年龄为66岁，94%的患者有不止一种动脉粥样硬化危险因素（高血压、糖尿病、冠状动脉疾病、吸烟），75%的患者曾接受过动脉重建手术。无手术死亡病例，术后唯一的并发症是无菌性血清肿，经抽吸后好转。在长达11年的后期随访中，3例移植物发生血栓形成，另有1例发生感染不得不移除；这些移植物失败未导致肢体丧失，实际后期通畅率为87%。对于有症状的近端锁骨下动脉疾病的治疗，有人建议采用颈动脉-锁骨下动脉旁路手术、胸内旁路手术和闭塞部位的动脉内膜切除术。然而，通过腋腋旁路手术，可以避免在这类老年高危患者群体中与颈动脉操作、在 notoriously treacherous（此处疑有误，可能是“notoriously treacherous”，意为“极其危险的”）锁骨下动脉上进行手术以及开胸手术相关的并发症。腋腋旁路手术安全且简单，出色的长期通畅率使其成为有症状锁骨下动脉疾病的首选治疗方法。
