Lowell R C, Mills J L
Vascular Surgery Service, Wilford Hall USAF Medical Center, Lackland AFB, Texas.
Cardiovasc Surg. 1993 Oct;1(5):530-5.
The use of axilloaxillary artery bypass grafting as a successful approach for patients with symptomatic atherosclerosis of the brachiocephalic arteries has been described but remains limited as a result of concern over its subcutaneous, trans-sternal position and long-term patency. The aim of this study was to help define the indications, complications and patency of axilloaxillary artery bypass grafting for the treatment of subclavian and innominate artery occlusive disease. A retrospective review was performed of ten patients who underwent this operation over a 15-year period at the authors' institution and of 253 cases reported in the literature. The most common complication was transient brachial plexopathy, occurring in 3.5% of patients, and graft infection or skin erosion was noted in 1.6%. Incidence of perioperative myocardial infarction, stroke and death was < 2%, in contrast to other approaches which may involve thoracotomy, sternotomy, or carotid dissection and clamping. Recent series, including the authors', report a long-term primary patency rate (> 5 years) of around 90%. Because of its ease of performance, low morbidity and mortality, and excellent long-term patency, the authors propose that the axilloaxillary artery bypass is the procedure of choice in appropriately selected patients with symptomatic occlusive disease of the innominate and subclavian arteries.
腋腋动脉搭桥术作为一种治疗头臂动脉症状性动脉粥样硬化的成功方法已被描述，但由于担心其皮下、经胸骨的位置和长期通畅性，其应用仍然有限。本研究的目的是帮助明确腋腋动脉搭桥术治疗锁骨下动脉和无名动脉闭塞性疾病的适应证、并发症和通畅率。对作者所在机构15年间接受该手术的10例患者以及文献报道的253例病例进行了回顾性分析。最常见的并发症是短暂性臂丛神经病变，发生率为3.5%，移植感染或皮肤糜烂发生率为1.6%。围手术期心肌梗死、中风和死亡的发生率<2%，这与可能涉及开胸、胸骨切开或颈动脉解剖和钳夹的其他方法形成对比。包括作者系列在内的近期研究报告长期原发性通畅率（>5年）约为90%。由于其操作简便、发病率和死亡率低以及长期通畅性良好，作者建议腋腋动脉搭桥术是适当选择的无名动脉和锁骨下动脉症状性闭塞性疾病患者的首选手术方法。
