鎖骨下動脈盗血症候群の外科的治療

-¹²³I-IMP-SPECT と^99mTc-HSA 上肢RI検査による脳血流および上肢血流の評価と手術適応, 手術選択-

抄録

Numerous operative procedures have been proposed for correction of the subclavian steal syndrome. To select reasonable operative procedures in the respective patients, we have studied the cerbral blood flow, especially in the posterior circulation, by ¹²³I-IMP-SPECT imaging, and the blood flow in the upper extremities by ^99mTc-HSA accumulation curve in 11 patients with subclavian steal syndrome. The causative lesions were left subclavian artery occlusion in 10 cases and inominate artery occlusion in 1 case. Although all patients presented distinct symptoms and signs of vertebrobasilar insufficiency, ¹²³I-IMP-SPECT early image demonstrated no evident finding of decreased blood flow in the posterior circulation. However, in the delayed image 5 out of 11 patients revealed laterality of IMP uptake in cerebellar hemisphere. Four patients presented symptoms of the upper extremities including arm claudication, and all of them revealed ^99mTc-HSA accumulation curve indicated decreased blood flow in the affected side of arm and forearm. We performed transposition of vertebral artery to common carotid artery in 7 patients without evidence of decreased blood flow in the upper extremities by ^99mmTc-HSA accumulation curve, common carotid-subclavian dacron graft bypass in 3 cases with evidence of decreased blood flow in the upper extremities, and arch aortacommon carotid dacron graft bypass for the innominate artery occlusion. When the ischemia in the anterior circulation had existed in patients with multiple cerebrovascular occlusive disease, we first corrected the anterior circulation, and then performed the revascularization for the posterior circulation mentioned above by staged operation, resulting in successful treatment of all patients. We conelude that to determinine surgical indication and select procedures for the subclavian steal syndrome, ¹²³I-IMP-SPECT imaging and ^99mTc-HSA accumulation curve of upper extremities are mandatory, and the priority of vascular reconstruction for the subclavian steal syndrome should be first aimed to correct the anterior circulation, then correct the posterior circulation and the circulation of upper extremities.