Perrault L P, Carrier M, Hudon G, Lemarbre L, Hébert Y, Pelletier L C
Department of Surgery, Montreal Heart Institute, Quebec, Canada.
Ann Thorac Surg. 1993 Oct;56(4):927-30. doi: 10.1016/0003-4975(93)90357-n.
From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for the treatment of subclavian artery stenosis before or after coronary artery bypass grafting (CABG) using the internal mammary artery (IMA). There were 8 men and 3 women, with a mean age of 57 +/- 7 years. Four patients had PTA 1 to 4 months before undergoing CABG with IMA grafts, because of either asymptomatic supraclavicular murmurs or neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent angina. Subclavian artery stenosis was on the left side in 9 patients, the right side in 1 patient, and bilateral in 1 patient. Ten PTA procedures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. There were three complications: one femoral artery thrombosis, one brachial plexus hematoma after an axillary approach, and one acute pulmonary edema after the procedure. Follow-up after PTA ranged from 1 to 60 months (mean, 38 +/- 17 months). Nine patients had no angina at follow-up and 2 had stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of restenosis in any of these patients at a mean follow-up of 38 months. Subclavian artery PTA is a useful alternative to IMA bypass grafting in patients with subclavian artery stenosis discovered preoperatively, and it is the treatment of choice for those presenting with post-CABG angina due to subclavian artery stenosis proximal to an IMA graft.
1987年1月至1992年1月，11例患者在冠状动脉旁路移植术（CABG）使用乳内动脉（IMA）之前或之后，接受了经皮腔内血管成形术（PTA）治疗锁骨下动脉狭窄。其中男性8例，女性3例，平均年龄57±7岁。4例患者在使用IMA进行CABG术前1至4个月接受PTA，原因是出现无症状的锁骨上杂音或神经系统症状。7例患者在使用IMA进行CABG术后2至37个月接受PTA，原因是复发性心绞痛。9例患者锁骨下动脉狭窄位于左侧，1例位于右侧，1例为双侧。9例患者的10次PTA手术成功。所有CABG术后心绞痛患者的缺血症状均得到缓解。有3例并发症：1例股动脉血栓形成，1例腋路手术后臂丛血肿，1例术后急性肺水肿。PTA术后随访时间为1至60个月（平均38±17个月）。9例患者随访时无心绞痛，2例运动时出现稳定型心绞痛（Ⅱ级）。上肢多普勒检查显示，在平均38个月的随访中，这些患者均无再狭窄迹象。锁骨下动脉PTA是术前发现锁骨下动脉狭窄患者IMA旁路移植术的一种有用替代方法，也是IMA移植近端锁骨下动脉狭窄导致CABG术后心绞痛患者的首选治疗方法。
