第一部分：锁骨下动脉近端闭塞的诊疗进展

    锁骨下动脉近端闭塞是一种常见的外周动脉疾病，发病率约为1.9%。其常见症状为上肢缺血、头晕、短暂性脑缺血发作。由于大部分锁骨下动脉疾病患者无临床症状，该疾病常被忽视。现分别介绍锁骨下动脉近端闭塞的五种常见诊断方法（无创四肢动脉血压、双功能超声、计算机断层血管成像、磁共振血管成像和数字减影血管造影）以及三种治疗方法（药物治疗、介入治疗和外科开放手术治疗）。

【关键词】 锁骨下动脉；锁骨下动脉-颈总动脉转位术；锁骨下动脉近端闭塞。

第二部分：锁骨下动脉-颈总动脉转位术在不能介入治疗的锁骨下动脉近端闭塞患者中的治疗研究

目的 探索锁骨下动脉-颈总动脉转位术(Subclavian-Carotid Transposition, SCT）在不能介入治疗（介入治疗失败、先天畸形、不愿行介入治疗）的锁骨下动脉近端闭塞患者中的治疗研究。

方法 回顾性分析从2016年5月至2018年12月采用SCT治疗的19例不能介入治疗的锁骨下动脉近端闭塞患者的临床资料等，进而分析SCT在锁骨下动脉近端闭塞治疗中的优势与劣势。

结果 19例患者手术均成功，随访时间分别1-3年，术后患侧锁骨下动脉近端的狭窄程度由100%±0%下降到12.7%±10.1%。所有患者术后症状均有改善，7例患者发生周围神经损伤（36.8%）。术后随访，7例周围神经损伤患者其中6例患者均恢复正常，仅1例患者（5.3%）未恢复，1年和3年通畅率均为100%，未出现围手术期死亡、中风、术后再次治疗等。

结论 对于不能介入治疗的锁骨下动脉闭塞患者，锁骨下动脉-颈总动脉转位术是一个理想的治疗方案。

【关键词】锁骨下动脉-颈总动脉转位术；锁骨下动脉闭塞；锁骨下动脉窃血综合征。

第三部分：椎动脉V1段狭窄性病变的诊疗进展

    我国每年有超200万的新发脑卒中患者以及大约150万人死于脑卒中，后循环系统导致的脑卒中或短暂性脑缺血发作占总患者数的25%-40%，9%的后循环系统脑卒中是由于椎动脉V1段狭窄导致的。对于椎动脉V1段狭窄患者进行早期诊断以及积极合理的治疗，将减少后循环系统脑卒中的发生率。本文将分别介绍椎动脉V1段狭窄性病变的四种常见诊断方法（彩色多普勒超声检查、计算机断层血管成像、磁共振血管成像、数字减影血管造影检查）以及三种治疗方法（药物治疗、介入治疗、外科手术治疗）。

【关键词】椎动脉；椎动脉V1段狭窄；椎动脉-颈总动脉转位术。 

第四部分：改良椎动脉-颈总动脉转位术治疗椎动脉V1段狭窄

目的 探索改良椎动脉-颈总动脉转位术(Vertebral-Carotid Transposition, VCT)在椎动脉V1段重度狭窄至闭塞患者中的治疗研究。

方法 回顾性分析从2016年10月至2018年12月采用改良VCT治疗的13例椎动脉V1段重度狭窄至闭塞患者的临床资料等，进而分析改良VCT在椎动脉V1段重度狭窄至闭塞治疗中的意义。

结果 本组患者男性10例，女性3例，平均年龄70.5±7.1岁。13例患者手术均成功，随访时间分别为1-3年，术后患侧椎动脉V1段的狭窄程度由86.8%±7.5%下降到17.4%±14.5%。所有患者术后症状均改善，６例患者出现暂时性周围神经损伤症状，术后随访发现其中４例患者周围神经损伤症状消失，1年和3年通畅率均为100%，未出现围手术期死亡、中风、术后再次治疗等。

结论 改良VCT能确切地恢复椎动脉V1段重度狭窄至闭塞患者的远端血流，改善其症状。

【关键词】椎动脉-颈总动脉转位术；椎动脉闭塞；椎动脉重度狭窄。

第五部分：一站式颈动脉内膜剥脱术联合椎动脉转位术的临床研究分析

目的 探索一站式颈动脉内膜剥脱术联合椎 动脉转位术在椎动脉V1段重度狭窄至闭塞合并同侧颈动脉重度狭窄至闭塞患者中的治疗研究。

方法 回顾性分析从2017年6月至2020年9月采用一站式颈动脉内膜剥脱术联合椎动脉转位术治疗的12例同侧颈动脉重度狭窄至闭塞合并椎动脉V1段重度狭窄至闭塞患者的相关资料等，进而分析一站式颈动脉内膜剥脱术联合椎动脉转位术在椎动脉V1段重度狭窄至闭塞合并同侧颈动脉重度狭窄至闭塞治疗中的意义。

结果 本研究患者男性10例，女性２例，平均年龄67.8±6.0岁。1２例患者手术均成功，随访时间分别为1-3年，术后患侧椎动脉V1段的狭窄程度由83.5%±11.8%下降到24.9%±14.3%（P<0.01），术后患侧颈动脉狭窄程度由85.6%±11.0%下降到0%（P<0.01）。术后随访显示术前有症状的患者症状较术前均有改善，椎动脉的1年和3年通畅率均为100%，未出现周围神经损伤、围手术期死亡、中风等。

结论 一站式颈动脉内膜剥脱术联合椎动脉转位术能同期处理同侧颈动脉狭窄和椎动脉狭窄病变，改善脑部血供，改善患者症状，具有较高的推广价值。

【关键词】一站式颈动脉内膜剥脱术联合椎动脉转位术；颈动脉内膜剥脱术；椎动脉转位术。

Part1: Diagnosis and Treatment of Proximal Subclavian Artery Occlusion

Abstract

Proximal subclavian artery occlusion (PSAO) is a common peripheral artery disease with an incidence of about 1.9%. The common symptoms are upper limb ischemia, dizziness, and transient cerebral ischemic attack. Because most patients with subclavian artery disease have no clinical symptoms, the disease is often overlooked. This article will introduce five common diagnostic methods (noninvasive extremity arterial blood pressure, dual-function ultrasound, computed tomography angiography, magnetic resonance angiography, digital subtraction angiography) and three treatment methods (drug therapy, interventional therapy, surgery operation treatment) for PSAO.

【Key words】 Subclavian Artery; Subclavian-carotid Transposition; Proximal subclavian artery occlusion.

Part 2: Subclavian-carotid transposition treating proximal subclavian artery occlusive disease

Abstract

Object: To study the efficacy of subclavian-carotid transposition in treating proximal subclavian artery occlusive disease.

Methods: A retrospective review of patients’ charts was done to collect 19 cases of subclavian artery occlusion who had undergone subclavian-carotid transposition from May 2016 to December 2018. Clinical data was collected to compare with those of subclavian artery interventional therapy.

Results: All patients achieved immediate remission of symptoms after surgery. The degree of stenosis of the proximal subclavian artery decreased from 100% ± 0% to 12.7% ± 10.1% after surgery. Peripheral nerve injury occurred in 7 patients (36.8%). 6 patients with neurological complication have relieved in follow-up. No perioperative stroke, death and re-operation happened.

Conclusion: Subclavian-carotid transposition is an ideal process for the subclavian artery occlusive patients who cannot accept subclavian artery interventional therapy.

【Keywords】Subclavian-carotid transposition; Subclavian artery occlusion; Subclavian steal syndrome.

Part 3: Progress in The Diagnosis and Treatment of Stenosis of The Vertebral V1 Segment

Abstract

    There are more than 2 million new stroke patients and about 1.5 million deaths from strokes in China each year. Strokes or transient ischemic attacks caused by the posterior circulatory system account for 25% to 40% of the total number of patients. 9% Stroke of the posterior circulatory system is caused by stenosis of the V1 segment of the vertebral artery. Early diagnosis and active and reasonable treatment of patients with vertebral artery V1 stenosis will reduce the incidence of posterior circulatory stroke. This article will introduce the four common diagnostic methods of vertebral artery V1 stenosis (color Doppler ultrasound, computed tomography, magnetic resonance angiography, digital subtraction angiography) and three treatment methods (drug treatment, Interventional treatment, surgical treatment).

【Key words】 Vertebral Artery; Stenosis of The Vertebral V1 Segment; Vertebral-Carotid Transposition.

Part 4: Modified vertebral-carotid transposition treating stenosis at V1 segment of vertebral artery

Abstract

Object: The aim of this report is to study the treatment of modified vertebral artery-carotid transposition (Vertebral-Carotid Transposition, VCT) in patients with severe vertebral artery V1 segment stenosis or vertebral artery V1 segment occlusion.

Methods: A retrospective review of patients charts was done to collect 13 cases of with severe stenosis or occlusion of the vertebral artery V1 segment treated by modified VCT were retrospectively analyzed from October 2016 to December 2018.

Results: There were 10 males and 3 females in this group, with an average age of 70.5±7.1 years. The operation was successful in this series patients. The follow-up duration was 1-3 years. The degree of stenosis of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury complication occurred in 6 patients. 4 patients with neurological complication have relieved in follow-up duration. The patency rate was 100% at 1 and 3 years. There were no perioperative deaths, strokes, and re-intervention. No postoperative stroke, death and re-operation happened. 

Conclusion: Modified VCT can precisely restore the distal blood flow of patients with severe vertebral artery V1 segment stenosis or vertebral artery V1 segment occlusion, and relief their symptoms.

【Keywords】 Vertebral-Carotid Transposition; vertebral artery occlusion; vertebral artery severe stenosis.

Part 5: Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis

Abstract

Objective To explore the treatment of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 and severe stenosis to occlusion of the ipsilateral carotid artery.

Methods From June 2017 to September 2020, 12 cases of carotid artery severe stenosis to occlusion combined with severe stenosis of the ipsilateral vertebral artery V1 segment treated with carotid endarterectomy combined with vertebral artery transposition were retrospectively analyzed.

Results In this study, there were 10 males and 2 females, with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The degree of stenosis of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3%（P<0.01）. The degree of stenosis of carotid artery decreased from 85.6%±11.0% to 0%（P<0.01）. Postoperative follow-up showed that the symptoms of patients with symptoms before surgery were improved. The 1-year and 3-year patency rates of the vertebral arteries were 100%, and there were no peripheral nerve injury complication, perioperative deaths and strokes.

Conclusion Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patient symptoms and has high promotion value.

【Key word】 carotid endarterectomy combined with vertebral artery transposition; carotid endarterectomy; vertebral artery transposition.