腋- 腋动脉旁路移植术治疗锁骨下窃血综合征的临床疗效

目的:观察腋-腋动脉人工血管旁路移植术治疗锁骨下窃血综合征的临床效果及椎动脉血流的改善情况.方法:回顾性分析7年间64例采取腋-腋动脉人工血管旁路移植术治疗动脉硬化性锁骨下动脉窃血患者的临床资料.结果:手术成功率100％,全组无围手术期死亡.5例出现伤口血肿,8例术后出现神经受累症状,未出现伤口或人工血管感染病例.获随访的55例患者中,49例症状改善,其中术前椎动脉窃血为4级的患者有94.87％ (37/39)血流改善；3级患者中,62.50％ (5/8)血流改善；2例术前为2级的患者,未见血流改善.2例术后症状无改善,4例术后3～25个月再次出现头晕及患肢麻木,该6例患者中,5例血流改善.术后患者双上肢血压差平均恢复为10.22 mmHg,4例人工血管血栓形成,4例新发脑梗死.结论:对于锁骨下动脉窃血的患者,腋-腋动脉人工血管旁路移植术是安全有效的,该术式可以有效改善椎动脉的血流,但椎动脉的血流改善与症状并不完全平行.

Axillo-axillary bypass grafting for subclavian steal syndrome

Objective: To investigate the clinical efficacy of axillo-axillary crossover bypass grafting for subclavian steal syndrome and its effect on improvement of vertebral blood flow. Methods: The clinical data of 64 patients with arteriosclerotic subclavian steal syndrome undergoing axillo-axillary prosthetic bypass grafting over the past 7 years were retrospectively analyzed. Results: The success rate for bypass surgery was 100%, and no perioperative death occurred in the entire group. Five patients developed wound hematoma, 8 patients had symptoms of nerve injury, and no case of wound or graft infection was noted after surgery. Among the 55 patients followed up, the symptoms in 49 cases were improved, and vertebral blood flow improvement was seen in 94.87% (37/39) of the patients with stage IV retrograde vertebral flow and in 62.50% (5/8) of the patients with stage III retrograde vertebral flow, but no improvement was found in the two patients with stage II retrograde vertebral flow. No symptomatic improvement was observed after surgery in two patients, and 4 patients developed dizziness or limb numbness again during 3 to 25 months following surgery, and 5 of these 6 cases had improvement of vertebral blood flow. After surgery, the mean pressure gradient between upper limbs reverted to 10.22 mmHg, prosthetic thrombosis occurred in 4 cases and new cerebral infarction developed in 4 cases. Conclusion: Axillo-axillary crossover bypass grafting is a safe and effective procedure for patients with subclavian steal. This procedure can effectively improve blood flow in the vertebral artery, but the vertebral flow improvement is not always associated with symptomatic improvement.