Extrathoracic Bypass of an Orifice Occlusive Lesion in the Arch Vessels: Case Reports and Literature Review

對於因主動脈幹分支閉塞而產生症狀之病患，其椎動脈會竊取腦部血流，逆向供應閉塞遠端之肢體，產生鎖骨下動脈竊流症候群。我們曾手術治療兩例鎖骨下動脈竊流症候群之病患。根據病患之臨床症狀，物理學檢查及血管攝影確定診斷。第一例病患之閉塞病灶位於左側鎖骨下動脈開口處，而第二位病患之病灶乃無名動脈開口之閉塞。我們利用8厘米的PTFE人工血管分別施予頸動脈至左側鎖骨下動脈繞道及頸動脈至頸動脈繞道手術。整個手術過程非常順利且沒有任何的併發症產生。兩位病患之症狀於手術後追蹤五年皆不復見。相較於使用血管支架之昂貴花費，使用PTFE人工血管於胸腔外繞道手術，既可以避免胸骨鋸開之後遺症，又可減少醫療支出，同時也是經皮氣球擴張術失敗後的理想治療方式。

關鍵字

頸動脈至頸動脈繞道手術；頸動脈至左側鎖骨下動脈繞道手術；胸腔外動脈繞道手術； PTFE人工血管；鎖骨下動脈竊流症候群

並列摘要

Arterial occlusive disease of the arch vessels is often associated with flow reversal in the vertebral artery of such patients, the so-called subclavian steal syndrome. We treated two such cases that were diagnosed based on symptoms, physical examination and angiography. In the first case, the occlusive lesion was found at the origin of left subclavian artery, while the occlusion was positioned at the origin of innominate artery in the second case. Acarotid-subclavian and a carotid-carotid bypass using 8-mm PTFE grafts were performed, respectively. No complications were noted and the patients have retained a symptom-free status during a follow-up of 5 years. Taking into account the expense of stenting and the patency rate, extrathoracic bypass surgery using a PTFE graft for the treatment of orifice occlusive lesions of arch vessels is cheaper and has an overall better patency rate. Furthermore, because it is the final choice of treatment after percutaneous transluminal angioplasty fails, it should be considered as an ideal therapy for lesions at the origin of arch vessels.

並列關鍵字

carotid-carotid bypass ； carotid-subclavian bypass ； extrathoracic arterial bypass ； PTFE graft ； subclavian steal syndrome

國際替代計量

Extrathoracic Bypass of an Orifice Occlusive Lesion in the Arch Vessels: Case Reports and Literature Review

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