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目的确定锁骨下动脉血管重建术是否可以避免和治疗冠状动脉和锁骨下动脉窃取综合征。方法1985年—2004年40名被诊断患有冠心病伴锁骨下动脉阻塞病,其中在冠状动脉移植手术前被诊断的病人为组1(n=10),冠状-锁骨下动脉窃取综合征发生在冠状动脉旁路移植手术后被诊断的病人为组2(n=30)。组1病人直接接受同侧锁骨下动脉旁路移植术和同侧乳内动脉被使用为至少冠状动脉旁路当中的一个管道。组2病人接受胸外锁骨下动脉-颈动脉旁路术,20例经皮下穿刺血管成形和支架术,作为冠状-锁骨下动脉窃取综合征的治疗。结果所有病人经过治疗后症状消失。一名病人接受了经皮血管成形和支架术后,死于进行性的肾衰竭。随访共计为117病人年(平均3.1年/病人)。组1血管旁路移植术后的开放率是100%(平均随访3.7年)。组2经过经皮穿刺血管内成形和支架术或旁路移植术后(平均随访2.9年)。结论锁骨下动脉血管重建术可以避免冠状-锁骨下动脉窃取综合征,并对其提供有效的治疗,同时降低了手术风险。中期随访显示旁路管道具有良好的开放率。
Objective To determine if subclavian revascularization can avoid and treat coronary and subclavian steal syndrome. Methods Between 1985 and 2004, 40 patients diagnosed as CHD with subclavian artery occlusion were enrolled. Among them, patients diagnosed before coronary artery transplantation were Group 1 (n = 10), and coronary-subclavian steal syndrome Patients who were diagnosed after coronary artery bypass grafting were Group 2 (n = 30). Group 1 patients received ipsilateral subclavian artery bypass grafting directly and the ipsilateral internal mammary artery was used as one of at least one of the coronary artery bypass. Group 2 patients underwent supraclavicular subclavian artery-carotid bypass surgery, 20 cases of percutaneous puncture angioplasty and stenting as a treatment for coronary-subclavian steal syndrome. Results All patients disappeared after treatment. One patient died of progressive renal failure after percutaneous angioplasty and stenting. Follow-up totaled 117 patient years (mean 3.1 years / patient). The open rate after group 1 bypass grafting was 100% (mean follow-up, 3.7 years). Group 2 was treated with percutaneous transluminal angioplasty and stenting or bypass grafting (mean follow-up, 2.9 years). Conclusion Subclavian revascularization can avoid coronary-subclavian steal syndrome and provide effective treatment and reduce the risk of surgery. Mid-term follow-up showed a good open rate of bypass tubing.