Aortocoronary saphenous vein graft aneurysm in redo coronary artery bypass grafting: Report of a case

(Received for publication on Oct. 14, 1996; accepted on Mar. 4, 1997)     

电视内镜下获取大隐静脉在冠状动脉旁路移植术中的应用

目的 探讨冠状动脉旁路移植术(CABG)中应用微创电视内镜下获取大隐静脉的手术要点和临床效果.方法 自2001年1月至2008年12月212例患者接受CABG,按照获取大隐静脉的方法分为两组:内镜组72例,传统组140例.比较分析两组患者的手术资料和术后并发症等情况.结果 内镜组获取静脉的时间与传统组比较差异无统计学意...     

The back-approach technique of endoscopic saphenous vein harvesting in coronary artery bypass grafting

PurposeOne of the concerns during endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting (CABG) is injury to the vein or its branches. The cutting edge of bipolar electrocautery scissors, used to divide the side branches of the saphenous vein, can cause vascular injury leading to reduced graft patency. We have developed a novel back-approach technique using a C-ring to divide the wide side branches of the saphenous vein during EVH. The aim of the study was to describe the technique and assess early outcomes of EVH using this technique. The back-approach technique is as follows: (a) insert the C-ring near the target branch, (b) push the C-ring over the proximal aspect of the target branch, (c) twist the C-ring forward to capture the target branch, and (d) cut the target branch by bipolar electrocautery.MethodsWe investigated 169 patients, including 35 women (mean age 70.1 ± 8.9 years), who underwent CABG at our hospital, using a novel EVH technique. The patients were categorized as those who underwent EVH (EVH group, n = 44) or open vein harvesting (OVH) (OVH group, n = 125). This method involves the creation of a small incision (2 cm), sufficient saphenous vein dissection near the skin incision, adequate dissection to separate the vein from the surrounding tissues, and the back-approach technique with C-ring to divide the side branch of the saphenous vein. The primary endpoint was the graft patency rate, and the secondary endpoints were leg wound complications and length of hospitalization.ResultsNo significant intergroup difference was observed in early patency of saphenous vein graft patency (OVH vs. EVH = 94.7 vs. 95.6%, p = 0.763). The incidence of lower extremity wound lymphorrhea was significantly lesser (OVH: EVH = 16.0: 0.0%, p = 0.005) and the length of hospitalization was also significantly shorter in the EVH group (OVH vs. EVH = 24.2 ± 9.8 vs. 19.0 ± 5.3 days, p = 0.001).ConclusionsEVH, using the back-approach technique, showed satisfactory short-term results; therefore, this technique performed with C-ring might be effective for vein harvesting during EVH.     

Surgical repair of a pseudoaneurysm derived from a nine-year-old saphenous vein graft after coronary artery bypass

A 57-year-old male presented intermittent pain between the left shoulder and neck. He had undergone coronary artery bypass twice and all grafts had been confirmed to be angiographically intact at three and a half years prior. Coronary angiography revealed that a pseudoaneurysm derived from around the proximal ascending aortic anastomosis of the saphenous vein graft that connected to the left anterior descending branch and #4-atrioventricular branch sequentially. The pseudoaneurysm compressed the saphenous vein graft itself. He underwent repair of the pseudoaneurysm through median sternotomy after left subclavian artery-saphenous vein graft bypass utilizing a free left radial artery without cardiopulmonary bypass through left anterolateral thoracotomy. A 7 mm length longitudinal tear in the saphenous vein graft near the proximal anastomosis had caused the pseudoaneurysm. This tear had likely been caused by perforation by a catheter during coronary arteriography three and a half years ago.     

Saphenous vein graft rupture eighteen years after coronary artery bypass grafting

Delayed saphenous vein graft (SVG) rupture following coronary artery bypass graft (CABG) is an unusual but potentially fatal complication. Herein we report a case of SVG rupture 18 years after CABG. A 75-year-old man had undergone a CABG with SVG in 1987 at another institution. In 2004 the patient developed angina and underwent re-CABG with arterial conduits in our hospital. On the preoperative cineangiogram, the SVG to the right coronary artery (RCA) was irregularly dilated, yet still providing flow to the distal RCA. In 2005 he was readmitted to our hospital for abdominal pain. Chest computed tomography revealed a huge round mass adjacent to the heart. Cineangiogram showed leakage of the contrast in the midportion of the SVG. At operation, graft rupture was evident and repaired under cardiopulmonary bypass. Although cardiac function was well maintained, after the surgery he developed ischemic colitis and died of multiple organ failure on the 17^th postoperative day. (Jpn J Thorac Cardiovasc Surg 2006; 54:178-181)     

Tuberculous osteomyelitis of tibial diaphysis following saphenous vein graft harvest for coronary artery bypass: a case report

Tuberculosis in the tibial diaphysis following saphenous vein graft harvest for coronary artery bypass grafting has not been reported, to the best of authors’ knowledge. We report the first such clinical case in view of its clinical rarity and as a complication of the simple procedure like saphenous vein graft harvest.     

急性腘动脉栓塞1例报告

患者,男,67岁,跌伤致腰背疼痛2周,突发左足及小腿疼痛麻木伴乏力1h来诊收住。患者于2周前因骑自行车跌伤致腰背疼痛在我院行MRI检查示:L2椎体Ⅰ度压缩骨折,无神经压迫症状,拒绝住院,回家卧床休息制动。1h前解大便时,突然出现右足趾麻木并向上蔓延至膝下,后感小腿后侧肌痉挛伴剧     

冠状动脉搭桥内镜大隐静脉获取术136例

目的探讨内镜辅助小切口获取大隐静脉进行冠状动脉搭桥手术的价值。方法411例冠状动脉搭桥手术,依据患者意愿采用微创小切口手术及传统开放大切口手术获取大隐静脉,其中136例应用内镜静脉获取术(endoscop icve in harvesting,EVH),275例应用开放静脉获取术(open ve in harvesting,OVH),比较2组患者手术情况以及下肢切口并发症发生率。结果EVH组下肢切口并发症总发生率为18.4%(25/136),显著低于OVH组36.7%(101/275)(2χ=14.406,P=0.000),其中下肢浮肿、感觉异常、血肿和液化发生率EVH组均低于OVH组,分别为1.5%(2/136)vs.35.3%(97/275)(2χ=56.861,P=0.000)、7.4%(10/136)vs.33.8%(93/275)(2χ=33.937,P=0.000)、16.2%(22/136)vs.27.3%(75/275)(2χ=6.214,P=0.013)和0.7%(1/136)vs.8.7%(24/275)(2χ=10.174,P=0.001)。总手术时间EVH组为(226.3±28.5)m in,OVH组为(224.7±19.2)m in,2组比较差异无显著性(t=0.673,P=0.502)。血管桥早期失功EVH组和OVH组各发生1例,2组比较差异无显著性(2χ=0.000,P=1.000)。远端吻合口数目EVH组(3.6±0.8)个,OVH组(3.3±1.0)个,2组比较差异有显著性(t=3.049,P=0.002),但临床意义不明显。结论内镜大隐静脉获取术可以显著降低高危患者的切口相关并发症,并不增加手术时间和血管桥早期失功发生率,亦不会减少远端吻合口数量而影响冠状动脉的完全再血管化治疗。     

Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery

BACKGROUND: Most coronary artery bypass grafting (CABG) operations still involve the use of greater saphenous vein (GSV) for one or more grafts, even with the increasing use of arterial conduits for coronary revascularization. Wound complications from GSV harvesting are common, and sometimes severe. In order to reduce the morbidity of this procedure, we adopted a technique of endoscopic vein harvesting (EVH). EVH allows nearly complete harvest of the GSV, with excellent visualization, through minimal incisions. At our institution, a physician's assistant routinely performs EVH, usually while a cardiothoracic surgeon harvests an arterial conduit. In 1997, all GSV harvesting was performed by open technique. During a transition period in 1998 and 1999 we used several different endoscopic techniques. By the beginning of 2000, our technique of EVH was standardized and used routinely. METHODS: To determine whether EVH reduced the morbidity associated with conventional open vein harvesting (OVH), we reviewed the charts of all patients having primary coronary artery bypass operations utilizing GSV during the years 1997 and 2000. RESULTS: The two groups were comparable in risk factors for leg incision complications. The year 2000 EVH group had a marked reduction in the number of wound complications compared with the year 1997 OVH group (7.1% versus 26.1%, P < 0.00001). There were no significant differences between the two groups in total operative time (OVH 224 minutes, EVH 223 minutes, number of distal coronary anastomoses (OVH 3.38 +/- 0.90, EVH 3.38 +/- 0.94), or the rate of clinically apparent early graft failure. There was a significant increase in the use of sequential grafting techniques in the 2000 group (OVH 21.9%, EVH 43.6%, P < 0.00001). CONCLUSIONS: EVH reduced the morbidity associated with GSV harvesting. EVH was associated with an increased use of sequential coronary grafting techniques. EVH does not prolong operative time when performed by experienced personnel. We believe EVH should become the standard of care.     

内镜下与常规切开法采集大隐静脉在冠状动脉旁路移植术中应用的比较

目的探讨内镜下采集大隐静脉应用于冠状动脉旁路移植术(coronary artery bypass grafting,CABG)中的早期临床效果。方法2004年4月~2005年5月,对89例采用内镜下取大隐静脉行CABG(内镜组),在膝关节中部做2 cm切口,应用VasoV iew 5内镜血管采集系统游离获取大隐静脉,并与2003年4月~2005年3月38例采用传统切开法取大隐静脉行CABG(常规组)进行比较,比较2组术后下肢切口并发症、恢复行走时间、患肢疼痛麻木感及肿胀、术后6个月通畅率。结果内镜组取大隐静脉2~3支,平均2.6支;内镜组下肢并发症(6例)与常规组(8例)相比明显减少(2χ=4.197,P=0.040);内镜组患肢疼痛、麻木感7例及肿胀9例与常规组(分别为36、30例)相比明显减少(2χ=89.740,P=0.000;2χ=59.299;P=0.000);内镜组恢复行走时间(2.3±0.9)d比常规组(3.4±1.6)d明显缩短(t=-4.952,P=0.000);内镜组术后6个月通畅率96.0%(48/50)与常规组95.3%(19/20)相比无明显差别(2χ=0.000,P=1.000)。结论CABG中应用内镜下采集大隐静脉能够减少创伤,明显降低术后下肢并发症,减轻术后下肢切口疼痛。     

Radial artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A meta-analysis

Objective

Individual studies may be limited by sample size to detect differences in late survival between radial artery (RA) or saphenous vein graft (SVG) as a second conduit for coronary artery bypass surgery. Here we undertook a meta-analysis of the best evidence available on the comparison of early and late clinical outcomes of the RA and the SVG.

内窥镜采集大隐静脉行冠状动脉旁路移植术1年随访

目的 总结应用内窥镜采集静脉(endoscopic vein harvesting,EVH)技术获取大隐静脉(greater saphenous vein,GSV)进行冠状动脉旁路移植手术(coronary artery bypass grafting,CABG)后1年随访结果,评估采用EVH技术的手术效果.方法 2009年5月至2010年5月,136例患者应用EVH取GSV进行的非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG),112例开放静脉获取术(open vein harvesting,OVH)取GSV进行的OPCABG.评估71例应用EVH和64例传统手术切口取GSV行OPCABG患者1年随访结果,比较两组患者手术情况、下肢切口并发症、1年后移植血管通畅率以及心理状况.结果 EVH组与OVH组比较,在创面大小、伤口恢复及美观化、伤口感染率、神经功能影响、二次清创缝合率以及下肢切口总体并发症发生率等方面具有明显优势.比较两组患者术后1年移植血管通畅率,EVH组动脉移植血管通畅率96.8％,静脉移植血管通畅率85.7％;OVH组动脉移植血管通畅率94.9％,静脉移植血管通畅率86.4％.两组随访结果中心绞痛再发率、动脉移植通畅率、静脉移植通畅率差异均无统计学意义.EVH组患者心理状况调查结果优于OVH组.结论 与常规OVH方法相比较,EVH技术对获取移植静脉具有更多优势,通过在采集前对患者进行部分肝素化等更具保护移植静脉材料的方法,EVH组也保持了满意的移植血管1年期通畅率.     

Adventitial cystic disease of the popliteal artery: diagnosis and treatment. A case report

Adventitial cystic disease of the popliteal artery (ACDPA) is an unusual cause of a unilateral progressive intermittent claudication in young or middle-aged men. In the case described here, ultrasound (US) examination provided the preoperative diagnosis. The lesion was dealt with by simple evacuation of the cyst and excision of the wall. This simple treatment is all that is required in the majority of cases and provides good long-term results.     

In situ versus reversed saphenous vein for femoropopliteal bypass: a prospective randomized study of 100 cases

With the purpose of comparing results using the greater saphenous vein in situ or as a reversed conduit, 100 femoropopliteal bypasses, performed in 91 patients between October 1980 and January 1985, were randomized into two statistically comparable groups of 50 procedures of each type. Seventy-five percent of patients had cutaneous signs of ischemia and 20% had isolated rest pain. Average follow-up was 32 months for the in situ group and 33.4 months in the reversed bypass group. The quality of the vein was statistically better in the in situ group (p<0.01). There were six cases of early thrombosis in the in situ group compared to four in the reversed bypass group. In the in situ group, half of the thromboses could be attributed to inadequate valviar destruction. Seven delayed thromboses were noted in the in situ group whereas there were two in the reversed saphenous vein bypass group. The actuarial rates of bypass patency at three years in the reversed and in situ groups were 88.2 and 70.8%, respectively (x2=2.62; NS). Analysis of results suggests that: 1) the reversed saphenous vein bypass provides excellent results if vein harvest and preparation are as atraumatic as possible; 2) expertise in rendering the valves incompetent markedly increases patency in thein situ technique; 3) during the first 12 months, Doppler follow-up of measured distal pressures is necessary in order to detect pathologic changes of the bypass and adjacent arterial tree.     

Use of single saphenous interposition vein graft for primary arterial circuit and secondary recipient site in head and neck reconstruction: a case report

BACKGROUND: Autologous vein grafts are a valuable tool in microsurgical free tissue transfer. Interposition vein grafts offer the surgeon greater freedom when placing the free flap and choosing the recipient vessels, providing valuable options in case recipient vessels are not available for those patients with large wounds. Free flaps transferred to head and neck regions carry a higher risk of failure, which may be expected to increase more with the use of vein grafts. METHODS: We present our case with the double use of a single vein graft for both primary arterial conduit in end-to-end fashion and secondary end-to-side recipient site in the microsurgical reconstruction of a complicated head and neck defect. RESULTS: All these anastomoses and flaps survived perfectly, and the patient was discharged 14 days after the transfer of the second flap. CONCLUSION: Although the anastomosis of 2 flaps to a single vein graft was successful in our case, it represents a higher risk option than different recipient vessels. We provide this alternative procedure in selected patients, as there is no other receipt vessel or recipient blood flow strong enough to supply more than 1 flap.     

骨梗塞1例报告

患者,男,34岁,水泥工,因右小腿肿痛20d就诊。20前右内踝出现一约0.3cm×0.3cm的包块,压痛,未引起重视,3d后包块消失。于入院前1周,右小腿及踝部肿胀、疼痛而收住我科。入院查体:右小腿中下段内侧沿大隐静脉走行皮肤呈红色,皮温略高,压痛不明显,可触及条索状改变。血常规:WBC5.1×109/L,HGB187g/L,PLT99×109/L,右下肢动静脉B超所见:右下肢股、腘、胫后、大隐、小隐静脉及动脉未见异常。X线片示:右侧胫骨中上段髓腔外后侧见条状不规则密度增高影,边界毛糙,长约10cm,该段髓腔变窄,右腓骨骨质未见异常(见图1)。诊断:①右胫骨中段骨梗塞;…     

Adventitial cystic disease of the popliteal artery communicating with the knee joint: A case report

We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery. (J Vasc Surg 1998;28:738-41.)