CAJ | 학술논문

目的评估锁骨下动脉支架植入术、腋-腋动脉旁路移植术(axilloaxillary bypass,AAB),颈-锁骨动脉旁路移植术(carotid-subclavian bypass,CSB)治疗锁骨下动脉硬化闭塞症的安全性及中远期疗效.方法 2001年1月至2013年1月首都医科大学宣武医院共手术治疗311例锁骨下动脉硬化闭塞症患者,其中男239例,年龄32 ～ 85岁,平均年龄(63±9)岁.锁骨下动脉支架植入术191例,AAB 96例,CSB 32例.平均随访(32±11)个月,观察围术期并发症及中远期通畅率.结果锁骨下动脉支架植入术,AAB,CSB3种术式围术期并发症分别为4.1％ (9/191),11.5％ (11/96),18.7％(6/32).支架植入术围术期并发症低于开放手术,AAB与CSB术式围术期并发症差异无统计学意义;锁骨下动脉支架植入术1,3,5年通畅率分别为90.3％,84％,81.6％;AAB组1,3,5年通畅率分别为:95.3％,92.6％,88.9％;CSB组1,3,5年通畅率:100％,96.4％,96.4％.两种旁路移植组的通畅率高于支架植入组.结论锁骨下动脉支架植入术、CSB,AAB是治疗锁骨下动脉硬化闭塞症安全有效的治疗方式.外科旁路手术移植术的中远期通畅率优于支架植入术.
목적 평고쇄골하동맥지가식입술、액-액동맥방로이식술(axilloaxillary bypass,AAB),경-쇄골동맥방로이식술(carotid-subclavian bypass,CSB)치료쇄골하동맥경화폐새증적안전성급중원기료효.방법 2001년1월지2013년1월수도의과대학선무의원공수술치료311례쇄골하동맥경화폐새증환자,기중남239례,년령32 ～ 85세,평균년령(63±9)세.쇄골하동맥지가식입술191례,AAB 96례,CSB 32례.평균수방(32±11)개월,관찰위술기병발증급중원기통창솔.결과 쇄골하동맥지가식입술,AAB,CSB3충술식위술기병발증분별위4.1％ (9/191),11.5％ (11/96),18.7％(6/32).지가식입술위술기병발증저우개방수술,AAB여CSB술식위술기병발증차이무통계학의의;쇄골하동맥지가식입술1,3,5년통창솔분별위90.3％,84％,81.6％;AAB조1,3,5년통창솔분별위:95.3％,92.6％,88.9％;CSB조1,3,5년통창솔:100％,96.4％,96.4％.량충방로이식조적통창솔고우지가식입조.결론 쇄골하동맥지가식입술、CSB,AAB시치료쇄골하동맥경화폐새증안전유효적치료방식.외과방로수술이식술적중원기통창솔우우지가식입술.
Objective To investigate the safety and medium-and long-term effects of endovascular stenting,axilloaxillary bypass (AAB),carotid-subclavian bypass (CSB) in patients of subclavian arterial occlusion.Method From 2001 to 2013,311 consecutive patients with subclavian arteriosclerosis obliterans were treated with endovascular stenting (n =191),axilloaxillary bypass (n =96) or carotidsubclavian bypass(n =32).We collected patients' medical data,calculated patency of the graft or stent with life-table method and compared patency between three approaches with Log-rank.Results The incidence of perioperative complications was 4.1％ in the stenting group vs.11.5％ in AAB group vs.18.7％ in CSB group.There was significant statistical differences between the stenting group and bypass group about the incidence of perioperative complications.The primary patency rates at 1,3 and 5 years were 90.3％,84％,81.6％ in stenting group vs.95.3％,92.6％,88.9％ for AAB group vs.100％,96.4％,96.4％ for CSB group.There was significant statistical differences between the stenting group and bypass group about the primary patency rates.Conclusions Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian arteriosclerosis obliterans.However,effect of extrathoracic surgical bypass is more durable in the medium-and long-term.