颈动脉-锁骨下动脉人工血管旁路移植术在重建入颅血供中的应用分析

Application analysis of carotid-subclavian artery blood vessel prosthesis bypass grafting in the reconstruction of cerebral blood supply

目的探讨应用颈动脉-锁骨下动脉人工血管旁路移植术重建入颅血供的临床疗效。方法回顾性收集2019年3月—2022年3月于首都医科大学附属北京天坛医院血管外科应用颈动脉-锁骨下动脉人工血管旁路移植术重建入颅血供的14例患者的临床资料, 分析手术的适用范围、临床疗效及相关并发症。结果 14例患者中, 男性12例, 女性2例;年龄47~74岁, 平均60.5岁。2例为颈总动脉长段狭窄并明显后扩张性病变, 12例为锁骨下动脉闭塞并椎动脉窃血。所有手术均顺利完成, 围手术期无脑梗死、心血管意外、淋巴漏及人工血管感染的发生。术后1例患者发生膈神经损伤。14例患者随访3~27个月, 平均14个月, 人工血管及吻合口均通畅, 椎动脉窃血消失, 无新发脑梗死, 上肢缺血和颅内缺血症状均缓解。结论颈动脉-锁骨下动脉人工血管旁路移植术既可用于重建后循环的入颅血供, 也可用于重建前循环的入颅血供, 手术安全, 效果确切。

Objective To study the application effect of carotid-subclavian artery blood vessel prosthesis bypass grafting in the reconstruction of cerebral blood supply.Methods The clinical data of 14 patients undergoing carotid-subclavian artery blood vessel prosthesis bypass grafting to reconstruct cerebral blood supply in the Department of Vascular Surgery,Beijing Tiantan Hospital,Capital Medical University from March 2019 to March 2022 was retrospective collected.And the surgical indications,clinical effect and complications were analyzed.Results There were 12 males and 2 females,aged from 47 to 74 years,with an average age of 60.5 years.Of 14 patients,2 patients suffered from common carotid artery stenosis with posterior dilatation,12 patients suffered from subclavian artery occlusion with vertebral artery steal.All the procedures were successfully performed without intraoperative cerebral infarction,cardiovascular accident,lymphatic leakage or artificial vascular infection.Phrenic nerve injury occurred in 1 patient after operation.During the follow-up of 3-27 months,average 14 months,there were no artificial vascular stenosis,anastomotic stenosis,vertebral artery steal,new cerebral infarction,upper limb ischemia or cerebral ischemia.Conclusion Carotid-subclavian artery blood vessel prosthesis bypass grafting can be used in reconstructing the blood supply of both the anterior circulation,and the posterior circulation safely and effectively.