Salam T A, Smith R B, Lumsden A B
Section of General Vascular Surgery, Emory University, Atlanta, Georgia.
Am J Surg. 1993 Aug;166(2):163-6; discussion 166-7. doi: 10.1016/s0002-9610(05)81049-9.
During a 10-year period ending in December 1991, 31 extrathoracic bypass procedures were performed in 29 patients for proximal common carotid artery atherosclerotic stenosis or occlusion. This included 16 men and 13 women, with a mean age of 63 years. Indications for surgery included transient ischemic attacks in 23 patients (79%), nonfocal symptoms in 4 patients (14%), and asymptomatic proximal common carotid artery stenosis associated with near-total occlusion of the internal carotid artery in 2 patients (7%). Severe proximal stenosis or complete occlusion of the common carotid artery was demonstrated angiographically in all cases. Subclavian-to-carotid bypass was performed in 26 cases and carotid-to-carotid bypass in 5 cases. Seventy-four percent of the bypass procedures were to the common carotid artery and 26% to the external carotid artery. Endarterectomy of the common carotid bifurcation was performed in conjunction with the bypass procedure in 13 cases and vertebral artery transposition in 2 other cases. Saphenous vein was used as the bypass conduit in 65% and prosthetic grafts in 35% of cases. There were no perioperative strokes or deaths in this series, and the mean postoperative hospital stay was 5 days. Follow-up ranged from 2 to 118 months (mean: 38.4 months). Graft occlusion occurred in two cases during the follow-up period (3-year patency rate: 90%), with recurrence of symptoms in one patient, which necessitated revision. Three patients had persistence or recurrence of symptoms despite patency of the graft, one other patient sustained a posterior circulation infarct, and there was one death unrelated to carotid vascular disease during the follow-up period. This experience shows that extrathoracic bypass procedures are safe and well tolerated for symptomatic proximal common carotid artery stenosis or occlusion. This method of reconstruction has excellent long-term patency and protection against further anterior circulation neurologic events.
在截至1991年12月的10年期间，29例患者接受了31次胸外旁路手术，以治疗颈总动脉近端动脉粥样硬化狭窄或闭塞。其中男性16例，女性13例，平均年龄63岁。手术指征包括23例患者（79%）出现短暂性脑缺血发作，4例患者（14%）出现非局灶性症状，2例患者（7%）出现与颈内动脉几乎完全闭塞相关的无症状性颈总动脉近端狭窄。所有病例血管造影均显示颈总动脉近端严重狭窄或完全闭塞。26例行锁骨下动脉至颈动脉旁路手术，5例行颈动脉至颈动脉旁路手术。74%的旁路手术是连接到颈总动脉，26%连接到颈外动脉。13例在旁路手术的同时行颈总动脉分叉内膜切除术，另外2例行椎动脉转位术。65%的病例使用大隐静脉作为旁路管道，35%的病例使用人工血管。本系列病例无围手术期卒中或死亡，术后平均住院时间为5天。随访时间为2至118个月（平均：38.4个月）。随访期间有2例发生移植物闭塞（3年通畅率：90%），1例患者症状复发，需再次手术。3例患者尽管移植物通畅但仍有症状持续或复发，另1例患者发生后循环梗死，随访期间有1例死亡与颈动脉血管疾病无关。这一经验表明，胸外旁路手术对于有症状的颈总动脉近端狭窄或闭塞是安全的，且耐受性良好。这种重建方法具有出色的长期通畅率，并能预防进一步的前循环神经事件。
