Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Vasc Surg. 2023 Jan;88:218-227. doi: 10.1016/j.avsg.2022.07.020. Epub 2022 Sep 2.
The recommendation of the European Society for Vascular Surgery (ESVS) is that vertebral revascularization combined with ipsilateral CEA (carotid endarterectomy) should not be performed in the same operation. ESVS believes that vertebral revascularization combined with ipsilateral CEA increases perioperative death/stroke rates. In our opinion, revascularization of the first segment of vertebral artery (V1) combined with ipsilateral CEA is safe compared to vertebral V1 revascularization in the perioperative period. The purpose of this study is to prove that revascularization of V1 segment of vertebral artery combined with ipsilateral CEA is secure in the perioperative period.
We describe our experience with homochronous revascularization of V1 segment of vertebral artery with ipsilateral CEA (group B) and simple revascularization of V1 segment of vertebral artery (group A) in 48 consecutive patients during a 5-year period. O.Y. (Ouyang) incisions were used in both groups. We compare the results of the 2 procedures with aspects of mortality, stroke, morbidity, incident rates of complications, and so on.
There was no significant difference between patients in group A and group B in terms of red blood cell reduction, postoperative ventilator using time, postoperative drainage volume, postoperative drainage days, postoperative hospitalize duration, and incident rates of postoperative complications. The postoperative complications include death, stroke, Horner syndrome, vocal paralysis, hypoglossal nerve paralysis, wound hematomas, and lymphatic leakage.
Revascularization of vertebral artery combined with ipsilateral CEA should be divided into revascularization of V1 segment of vertebral artery combined with ipsilateral CEA and revascularization of V3 segment of vertebral artery with ipsilateral CEA. Revascularization of V1 segment of vertebral artery combined with ipsilateral CEA is safe; it can be performed for suitable patients who are fit for indications. O.Y. incisions can fully expose the target blood vessels and simplify the procedures without transecting the sternocleidomastoid muscles in operations.
欧洲血管外科学会（ESVS）建议，不应在同一手术中进行椎动脉再血管化联合同侧颈内动脉内膜切除术（CEA）。ESVS 认为，椎动脉再血管化联合同侧 CEA 会增加围手术期死亡/中风的发生率。在我们看来，与围手术期椎动脉 V1 段再血管化相比，椎动脉 V1 段再血管化联合同侧 CEA 是安全的。本研究旨在证明椎动脉 V1 段再血管化联合同侧 CEA 在围手术期是安全的。
我们描述了在 5 年期间对 48 例连续患者进行同侧椎动脉 V1 段同期再血管化（B 组）和单纯椎动脉 V1 段再血管化（A 组）的经验。两组均采用 O.Y.（欧阳）切口。我们比较了两种手术方法在死亡率、中风、发病率、并发症发生率等方面的结果。
A 组和 B 组患者在红细胞减少量、术后呼吸机使用时间、术后引流量、术后引流天数、术后住院时间和术后并发症发生率等方面无显著差异。术后并发症包括死亡、中风、霍纳综合征、声带麻痹、舌下神经麻痹、伤口血肿和淋巴漏。
椎动脉联合同侧 CEA 再血管化应分为椎动脉 V1 段联合同侧 CEA 再血管化和椎动脉 V3 段联合同侧 CEA 再血管化。椎动脉 V1 段联合同侧 CEA 再血管化是安全的；它可以为适合适应证的合适患者进行。O.Y. 切口可以充分暴露靶血管，并简化手术程序，而无需横断胸锁乳突肌。
