用皮下隧道法进行颈总动脉闭塞的微创帽状旁路手术 - 技术说明。

Surgical neurology international Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI:10.25259/SNI_528_2024
Yusuke Sakamoto, Sho Okamoto, Ryuta Saito
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引用次数: 0

摘要

背景:颈总动脉闭塞(CCAO)有时需要进行血管重建。由于颈外动脉血流不足,同侧颞浅动脉(STA)-大脑中动脉(MCA)搭桥术并不适合。帽状旁路是治疗 CCAO 的一种方法,需要一个长的冠状切口和骨槽,以防止插管移植物错位和塌陷。然而,这种长切口可能会导致皮肤并发症和侧支血流减少:方法:一名 60 岁的男性反复发生缺血性中风,右侧颈内动脉闭塞,左侧 CCAO。左侧 STA 无法使用,但右侧 STA 的两个分支都很发达。由于患者患有糖尿病,尽量减少皮肤侵犯是首要任务。我们使用间歇性皮肤小切口进行了右侧 STA 顶叶支-右侧 MCA 吻合术,然后进行了右侧 STA 额叶支-左侧桡动脉移植术(RAG)-左侧 MCA 帽状旁路术:结果:我们通过间歇性皮肤小切口钻了一个骨槽,延伸至插管移植物的整个长度。此外,我们采用了右侧STA-RAG端对端吻合,而不是端对端吻合,以保留侧支皮肤吻合。术后,旁路仍然通畅,患者无并发症,顺利出院:结论:脐带搭桥术是一种潜在的 CCAO 治疗方法,但该手术具有创伤性。我们的改良脐带搭桥法可以减少创伤,防止插管移植物塌陷和错位,最大限度地减少皮肤并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note.

Background: Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow.

Methods: A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch - right MCA anastomosis, followed by a right STA frontal branch - left radial artery graft (RAG) - left MCA bonnet bypass using small intermittent skin incisions.

Results: We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications.

Conclusion: The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

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