Owens L V, Tinsley E A, Criado E, Burnham S J, Keagy B A
Department of Surgery, University of North Carolina, Chapel Hill School of Medicine, USA.
J Vasc Surg. 1995 Sep;22(3):217-21; discussion 221-2. doi: 10.1016/s0741-5214(95)70133-8.
The purpose of this study was to review the various extrathoracic reconstruction options in patients with occlusive disease of the supraaortic trunks and to define the efficacy of these procedures in maintaining graft patency and relieving symptoms.
Forty-four consecutive patients underwent 47 extrathoracic bypass procedures of the supraaortic trunks for correction of symptomatic subclavian (SCA), common carotid (CCA) or innominate (INA) artery occlusive disease between July 1975 and May 1994. SCA stenosis (n = 27) was associated with upper extremity claudication (55%), vertebrobasilar insufficiency (15%), or both (30%). CCA stenosis (n = 14) was accompanied by hemispheric symptoms in 86% and global ischemia in 14%, whereas INA stenosis (n = 3) was associated with transient ischemic attacks (67%) and right arm ischemia (33%).
SCA revascularization included carotid-subclavian or carotid-axillary bypass (n = 19), axilloaxillary bypass (n = 8), and subclavian-carotid transposition (n = 3). CCA reconstructions included subclavian-carotid (SC) bypass (n = 13) and carotid-carotid bypass (n = 1). INA procedures included three axilloaxillary bypasses. Six patients had an associated carotid endarterectomy, and three underwent concomitant vertebral artery transpositions. Intraluminal shunts were not routinely used. Vein was used as a conduit in five procedures, and a prosthetic graft (23 Dacron, 16 polytetrafluoroethlyene) was used in the remainder. The average postoperative intensive care unit and hospital and hospital stay were 1 and 5 days, respectively. Follow-up was available in 43 of 44 patients (mean = 26.2 months). The perioperative mortality rate was 2.2% (one axilloaxillary). There were five graft occlusions in procedures involving the axillary artery (3 of 11 axilloaxillary, 2 of 7 carotid-axillary) as compared with one of 29 thromboses when the operation was confined to the supraclavicular fossa (p < 0.05) Relief of symptoms was achieved in all patients with patent grafts. There were no perioperative strokes in the series. Other complications included one brachial plexus neuropraxia (axilloaxillary) and four patients with phrenic nerve neuropraxia.
Extrathoracic revascularization of the supraaortic trunks is well tolerated and durable when operations are confined to the supraclavicular fossa and do not involve the axillary artery.
本研究旨在回顾主动脉弓上闭塞性疾病患者的各种胸外重建选择，并确定这些手术在维持移植物通畅和缓解症状方面的疗效。
1975年7月至1994年5月期间，44例连续患者接受了47次主动脉弓上胸外旁路手术，以纠正有症状的锁骨下动脉（SCA）、颈总动脉（CCA）或无名动脉（INA）闭塞性疾病。SCA狭窄（n = 27）与上肢间歇性跛行（55%）、椎基底动脉供血不足（15%）或两者兼有（30%）相关。CCA狭窄（n = 14）伴有半球症状的占86%，全脑缺血的占14%，而INA狭窄（n = 3）与短暂性脑缺血发作（67%）和右臂缺血（33%）相关。
SCA血运重建包括颈动脉-锁骨下动脉或颈动脉-腋动脉旁路（n = 19）、腋-腋动脉旁路（n = 8）和锁骨下动脉-颈动脉转位（n = 3）。CCA重建包括锁骨下动脉-颈动脉（SC）旁路（n = 13）和颈动脉-颈动脉旁路（n = 1）。INA手术包括三次腋-腋动脉旁路。6例患者同时进行了颈动脉内膜切除术，3例患者同时进行了椎动脉转位。未常规使用腔内分流器。5例手术使用静脉作为移植物，其余使用人工血管（23例涤纶、16例聚四氟乙烯）。术后平均重症监护病房停留时间和住院时间分别为1天和5天。44例患者中有43例获得随访（平均 = 26.2个月）。围手术期死亡率为2.2%（1例腋-腋动脉旁路手术）。涉及腋动脉的手术中有5例移植物闭塞（11例腋-腋动脉旁路中有3例，7例颈动脉-腋动脉旁路中有2例），而手术局限于锁骨上窝时29例血栓形成中有1例（p < 0.05）。所有移植物通畅的患者症状均得到缓解。该系列中无围手术期卒中。其他并发症包括1例臂丛神经失用（腋-腋动脉旁路）和4例膈神经失用。
当手术局限于锁骨上窝且不涉及腋动脉时，主动脉弓上胸外血运重建耐受性良好且持久。
