Becquemin J P, Gasparino L F, Etienne G
Service of Vascular Surgery, Henry Mondor Hospital, Creteil, France.
J Cardiovasc Surg (Torino). 1994 Aug;35(4):321-4.
Symptomatic subclavian artery damage, following radiation for breast or head and neck cancer, is very rare. We report three new cases in which arterial insufficiency of the upper limb developed respectively 3, 36, and 27 years after irradiation for breast cancer in two cases and tumor of the clavicle in one case. Patients were treated by saphenous vein by-pass using a new extra-anatomic route from the carotid to the brachial artery. They were two main differences from the classical carotido-brachial by-pass. The brachial artery was approached by a lateral mid-arm incision between the biceps and the humeral bone, and the grafts were tunnelled, subcutaneously, laterally on the medial head of the deltoid muscle avoiding the hump of the clavicle, and then between the biceps and the humeral bone. The postoperative courses were uneventful with good healing of the wounds. All grafts remained long-term patent and no compression was detected by ultrasound and arteriogram. This new technique of extra-anatomic carotido-brachial by-pass is a safe and efficient alternative to treat radiation induced injury of the subclavian artery.
乳腺癌或头颈癌放疗后出现有症状的锁骨下动脉损伤非常罕见。我们报告了3例新病例，其中2例乳腺癌放疗后分别于3年、36年出现上肢动脉供血不足，1例锁骨肿瘤放疗后27年出现上肢动脉供血不足。患者采用大隐静脉旁路术治疗，采用一种新的从颈动脉到肱动脉的解剖外途径。与经典的颈动脉-肱动脉旁路术有两个主要区别。通过肱二头肌和肱骨之间的上臂外侧中部切口暴露肱动脉，移植物经皮下在三角肌内侧头外侧隧道潜行，避开锁骨隆起，然后在肱二头肌和肱骨之间通过。术后病程顺利，伤口愈合良好。所有移植物长期通畅，超声和动脉造影未检测到压迫。这种新的解剖外颈动脉-肱动脉旁路术是治疗放疗引起的锁骨下动脉损伤的一种安全有效的替代方法。
