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冠状动脉旁路移植术(CABG)是治疗冠心病的主要手段之一,大隐静脉是CABG中最常使用的桥血管。但是在临床中大隐静脉的远期通畅率却不尽人意,超过50%的大隐静脉在移植后10年内闭塞。提高大隐静脉通畅率成为临床上亟待解决的问题。一种新型的“No-Touch”技术被报道可以大大提高大隐静脉的远期通畅率——在获取大隐静脉时保留外膜以及血管外周组织,减少器械对静脉的接触,避免高压扩张。尽管目前已有多项“No-Touch”技术的临床试验在进行之中,但No-Touch技术提高大隐静脉通畅率的机制还不十分清楚。 相似文献
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目的 通过Meta分析的方法评价No-touch大隐静脉技术与传统技术行冠状动脉旁路移植术(CABG)的疗效差异.方法 计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库(WanFang Data)、维普(VIP)、PubMed、Cochrane Library临床试验注册数据库、E... 相似文献
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李丽 《国外医学:心血管疾病分册》2005,32(5):296-299
大隐静脉桥(SVG)病变是冠状动脉旁路移植(CABG)术后患者心绞痛复发的主要原因,经皮介入治疗(PCI)是治疗SVG的常用方法.SVG病变往往为较大、松软、易碎的斑块,内含大量坏死组织、胆固醇结晶、泡沫细胞以及血细胞成分,因此PCI面临的包括术中远段血管栓塞等并发症高、术后再狭窄率高以及临床MACE发生率高等问题.早期的SVG介入治疗经验主要参考了自体冠脉的PCI,如球囊预扩张后植入支架、高压释放支架、使用GPⅡb/Ⅲa受体拮抗剂等,但是近年的循证医学研究主张对于SVG行PCI应采用直接支架术及小直径支架低压释放,术中采用远端保护装置等. 相似文献
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目的 冠状动脉旁路移植术是治疗缺血性心脏病一种常规方法 ,但是由于所采用的移植血管不同 ,导致治疗的效果也不尽相同。目前治疗常用的血管为大隐静脉 +乳内动脉为标准手术术式。然而诸多原因限制 ,有时大隐静脉不适合作为移植材料。本研究对大隐静脉与上臂头静脉作为移植材料进行比较。方法 接受乳内动脉和大隐静脉旁路移植术组 35例 ,平均年龄 77岁 ,接受乳内动脉 +上臂头静脉旁路移植术组 15例 ,平均年龄 75岁 ,二组之间 ,体重 ,心肌梗死病史 ,心功能 ,平均每例冠状动脉病变以及平均移植血管数没有明显差别。结果 乳内动脉和大隐静脉旁路移植术组和乳内动脉 +上臂头静脉旁路移植术组之间 ,乳内动脉的五年累计通畅率分别为 96 %和94 % ,二组之间没有显著性差异 (P>0 .0 5 ) ,大隐静脉的通畅率为 70 % ,上臂头静脉为 4 8% ,二组之间差异性不明显 (P>0 .0 5 )。结论 通过两组间的 5年累计通畅率的比较 ,我们认为在高龄病人上臂头静脉作为移植血管效果差 ,术后通畅率低 ,但可以作为移植血管的最后选择。 相似文献
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大隐静脉是冠状动脉旁路移植手术中重要的移植血管,但取大隐静脉需行下肢切口,可能出现并发症,增加患者痛苦且影响下肢美观.本组研究对比间断小切口与长切口取大隐静脉方法的优缺点,现报告如下. 相似文献
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大隐静脉桥(SVG)病变是冠状动脉旁路移植(CABG)术后患者心绞痛复发的主要原因,经皮介入治疗(PCI)是治疗SVG的常用方法.SVG病变往往为较大、松软、易碎的斑块,内含大量坏死组织、胆固醇结晶、泡沫细胞以及血细胞成分,因此PCI面临的包括术中远段血管栓塞等并发症高、术后再狭窄率高以及临床MACE发生率高等问题.早期的SVG介入治疗经验主要参考了自体冠脉的PCI,如球囊预扩张后植入支架、高压释放支架、使用GPⅡb/Ⅲa受体拮抗剂等,但是近年的循证医学研究主张对于SVG行PCI应采用直接支架术及小直径支架低压释放,术中采用远端保护装置等. 相似文献
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【】 目的 对比高龄冠状动脉旁路移植术(CABG)患者常规切开与内窥镜法采集大隐静脉下肢并发症的发生情况,评价内窥镜下采集大隐静脉用于高龄CABG患者的临床效果。方法 选取2014年06月至2015年12月于我院行冠状动脉旁路移植术高龄患者196 例,分为内窥镜静脉采集组(EVH 组,98 例)和常规切开静脉采集组(CVH 组,98例),比较两种静脉采集方法的术后下肢并发症的情况。 结果 与CVH组相比,EVH组在切口长度、术后疼痛评分、术后并发症和住院时间均小于CVH组,两组差异具有统计学意义(P<0.05);两组采集的大隐静脉质量、总手术时间及住院费用等方面差异无统计学意义(P>0.05)。结论 应用内窥镜采集大隐静脉能够明显降低高龄患者冠状动脉旁路移植术后下肢并发症的发生率,早期效果满意。内窥镜采集大隐静作为一种微创取血管的方法,对于高龄冠状动脉旁路移植术患者是安全的和值得推荐的。 相似文献
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E Solakovic 《Phlébologie》1988,41(1):235-241
Obstruction of the superficial femoral vein is, most of the time, secondary to atheroma. It is possible to correct it with a reconstructive procedure such as a by-pass. The results of 55 femoro-popliteal by-passes show that the mean age of the patients is between 50 and 60 years, that they are male, and often inveterate smokers. It is Fontaine's 2nd degree ischemia which is observed most of the time. The greater saphenous vein was always satisfactorily used. Three years after the procedure, the results of this venous autograft were studied and we noticed only four obstructions of the graft. These results seem related to higher fibrinogen levels, a defective heart condition, an insufficient diameter of the arteries receiving the graft. Only one leg amputation was performed at the level of the knee. 相似文献
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Objective
Platelets are involved in the pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in red blood cell distribution width (RDW) and platelet distribution width (PDW) values. Therefore, in this study we aimed to investigate whether PDW and RDW are associated with the patency of saphenous vein graft in patients at least 1 year after coronary artery bypass graft (CABG) surgery.Methods
Patients who had undergone CABG surgery at least 1 year previously with at least one saphenous vein graft were included in the study population. Patients were referred to cardiac catheterization for stable anginal symptoms or positive stress test results. Before coronary angiography, all patients referred had routine blood tests including RDW and PDW values.Results
Saphenous vein grafts were found to be patent in 69 patients and occluded in 40 patients. Although RDW levels were similar between patients with patent and occluded grafts (13.1?±?1.1% and 13.2?±?0.7% respectively, p?=?0.37), PDW levels were significantly different between the two groups (13.1?±?1.3% and 14.1?±?1.1 respectively, p?=?0.03). Although time after CABG operation differs significantly between the two groups (p?<?0.001), multiple logistic regression analyses showed that PDW levels were found to be significantly associated with the patency of vein graft (β?=?1.682, 95% CI 1.117–2.532, p?=?0.013).Conclusion
Our results showed that PDW levels were higher in patients with an occluded saphenous vein graft. However no association was found between the saphenous vein graft disease and RDW values. To verify this relationship between PDW values and saphenous vein graft patency, further investigations are needed. 相似文献15.
Distal filter protection during saphenous vein graft stenting: technical and clinical correlates of efficacy 总被引:3,自引:0,他引:3
Stone GW Rogers C Ramee S White C Kuntz RE Popma JJ George J Almany S Bailey S 《Journal of the American College of Cardiology》2002,40(10):1882-1888
OBJECTIVES: The aim of this study was to evaluate the clinical, angiographic, and technical factors related to successful stenting of diseased saphenous vein grafts (SVGs) using a novel filter-based distal protection device. BACKGROUND: Protection of the distal microvasculature with a balloon occlusion and aspiration system has been shown to reduce atherothrombotic embolization and peri-procedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) in SVGs. The safety, efficacy, and technical factors relating to procedural success with filter-based distal protection devices are unknown. METHODS: Percutaneous coronary intervention was performed in 60 lesions in 48 patients undergoing SVG intervention with the FilterWire EX distal protection system in a phase I experience at six sites. A larger phase II study was then performed in 248 lesions in 230 SVGs at 65 U.S. centers. RESULTS: Cumulative adverse events to 30 days occurred in 21.3% of patients in phase I, including a 19.1% rate of MI. Numerous anatomic, device-specific, and operator-related contributors to these adverse events were identified, resulting in significant changes to the protocol and instructions for use. Subsequently, despite similar clinical and angiographic characteristics to the phase I patients, the 30-day adverse event rate in phase II was reduced to 11.3% (p = 0.09), due primarily to a lower incidence of peri-procedural Q-wave and non-Q-wave MI. CONCLUSIONS: Distal protection during SVG PCI with the FilterWire EX is associated with a low rate of peri-procedural adverse events compared to historical controls. A unique set of anatomic, technical, and operator-related issues exist with distal filters which, if ignored, may reduce their effectiveness. 相似文献
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Alan L. Smuckler Alfred J. Rufty Robert N. Headley Rebecca Welbourne 《Catheterization and cardiovascular interventions》1982,8(5):507-512
Selective intracoronary infusion of streptokinase during the acute phase of myocar-dial infarction may reduce myocardial necrosis. Thrombolytic therapy of acute myocardial infarction has been primarily applied to the native coronary circulation. We are reporting successful thrombolysis in an aortocoronary saphenous vein graft 39 months after bypass surgery. Thrombosis may have developed as a complication of catheterization, and streptokinase may also prove useful in the reversal of thrombosis in this setting. 相似文献
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