Edwards W H, Tapper S S, Edwards W H, Mulherin J L, Martin R S, Jenkins J M
Department of Surgery, St. Thomas Hospital, Nashville, Tennessee.
Ann Surg. 1994 Jun;219(6):673-7; discussion 677-8. doi: 10.1097/00000658-199406000-00010.
Twenty-five years of experience with subclavian revascularizations were reviewed to determine the long-term patency rates of different extrathoracic approaches.
Although it is generally agreed that proximal subclavian stenosis should be treated by an extrathoracic route whenever possible, the optimum procedure is debated. Alternatives include subclavian carotid bypass, subclavian-to-subclavian or axillo-axillary bypasses, and the authors' preferred technique of subclavian carotid transposition (SCT).
Records were researched for the past 25 years in a single specialty surgical clinic for extrathoracic subclavian revascularizations. One hundred ninety such procedures were identified, and hospital charts and office medical records were reviewed for procedure, preoperative symptoms, blood pressure differentials, and postoperative complications. Patency was determined by physical examination, differential blood pressures, Doppler spectral analysis, duplex examinations, and arteriography.
Bypass procedures were used infrequently, and although the results are reported, they are excluded from any analysis. Subclavian carotid transposition was used in 178 procedures. All anastomoses were found to be patient at follow-up, except for one, which failed at 26 months. Mean follow-up was 46 months, with five patients lost to follow-up. Overall mortality rate was 2.2%, with the mortality falling to 1.1% if only subclavian carotid transposition patients are included.
Subclavian carotid transposition should be the treatment of choice for routine subclavian carotid occlusive disease because of its exceptional long-term patency and low morbidity.
回顾25年锁骨下血管重建经验，以确定不同胸外入路的长期通畅率。
尽管人们普遍认为，只要有可能，近端锁骨下狭窄应通过胸外途径治疗，但最佳手术方式仍存在争议。替代方法包括锁骨下-颈动脉搭桥术、锁骨下-锁骨下或腋-腋搭桥术，以及作者首选的锁骨下-颈动脉转位术（SCT）。
在一家专科外科诊所研究过去25年中胸外锁骨下血管重建的记录。共识别出190例此类手术，并查阅医院病历和门诊医疗记录，了解手术情况、术前症状、血压差异和术后并发症。通过体格检查、血压差异、多普勒频谱分析、双功超声检查和血管造影来确定通畅情况。
搭桥手术使用较少，尽管报告了结果，但在任何分析中都将其排除。178例手术采用了锁骨下-颈动脉转位术。随访发现，除1例在26个月时失败外，所有吻合口均通畅。平均随访46个月，5例患者失访。总体死亡率为2.2%，仅纳入锁骨下-颈动脉转位术患者时，死亡率降至1.1%。
由于其出色的长期通畅率和低发病率，锁骨下-颈动脉转位术应成为常规锁骨下-颈动脉闭塞性疾病的首选治疗方法。
