锁骨下动脉窃血综合征:椎动脉和乳内动脉彩色多普勒超声血流变化

Subclavian steal syndrome: changes of blood flow of vertebral arteries and internal mammary arteries on color Doppler ultrasonography

目的探讨锁骨下动脉窃血综合征患者椎动脉和乳内动脉血流变化。方法应用彩色多普勒超声检查17例锁骨下动脉窃血综合征患者的患侧椎动脉和乳内动脉,判断血流方向和进行血流频谱分析。结果椎动脉Ⅰ度窃血5例,乳内动脉血流方向均为正向血流。椎动脉Ⅱ度窃血7例,乳内动脉有3例收缩期出现低速短暂的反流,其余4例为正向血流。椎动脉Ⅲ度窃血5例中,有4例乳内动脉为全心动周期的反向血流,1例收缩期出现反向血流。结论锁骨下动脉窃血综合征患者患侧椎动脉可出现不同程度的窃血;而乳内动脉也可通过侧支循环发生反向血流,参与代偿上肢动脉供血。椎动脉和乳内动脉的收缩期血流变化均早于舒张期。

Objective To evaluate the blood flow changes of vertebral artery （VA） and internal mammary artery （IMA） in patients with subclavian steal syndrome （SSS）. Methods The directions and hemodynamics of the ipsilateral VAs and IMAs in 17 patients with SSS were analyzed with color Doppler uhrasonography. Results According to the flow direction of ipsilateral VA, SSS were defined as stage Ⅰ （5 cases） with decreased velocity in systolic phase, stage Ⅱ （7 cases） with retrograde flow only in systolic phase, stage Ⅲ （5 cases） with retrograde flow in both systolic and diastolic phases. All cases of stage Ⅰ and 4 of stage Ⅱ with normal of flow directions in ipsilateral IMAs, 1 IMA in stage Ⅲ and 3 IMAs in stage Ⅱ with retrograde flow only in systolic phase, 4 IMAs in stage Ⅲ with completely retrograde flow. Conclusion VA showed variant degree of steal phenomena in SSS patients. The blood flow of ipsilateral IMAs also demonstrated variant changes, such as decreased velocity or retrograde flow in systolic phase, even completely retrograde flow in both systolic and diastolic phases, in order to apply blood to the ipsilateral arm. The changes of blood flow in both VA and IMA appeared earlier in systolic phase than in diastolic phase.