冠状动脉与冠脉搭桥术常用自体血管的比较研究进展

冠脉搭桥术 (coronaryarterybypassgrafting ,CABG)在发达国家已成为心外科常规手术而普遍开展 ,在我国 ,自北京阜外医院开展第一例冠脉搭桥手术至今已 2 0多年 ,该手术在全国的开展正逐步增多。冠状动脉狭窄部位好发于前室间支 ,其次为右冠状动脉和旋支 ,CABG手术的目的是为阻塞的部位建立侧支循环恢复其血供。目前临床应用的冠脉搭桥移植材料有自体血管和人造血管两种 ,人造血管因有较多的并发症 ,只是在采用病人自体血管有禁忌症时作替代使用[1] ;常用的自体血管桥有大隐静脉、胸廓内动脉、胃网膜右动脉和桡动脉 4种。现就冠状动脉与…     

桡动脉解剖及获取技术在冠状动脉搭桥手术中的应用

目的：探讨冠状动脉搭桥术中桡动脉的获取技术方法及应用效果。方法：回顾性总结72例冠状动脉搭桥手术中取桡动脉的经验，介绍获取桡动脉的技术方法和体会。结果：在使用桡动脉获取技术的患者中，3例出现手术切口及手背皮肤术后短时间内麻木，其他患者无前臂感觉及活动障碍，无前臂缺血并发症。结论：当术前评价证实手部桡动脉供血区域有足够的侧枝循环时，桡动脉是最好的搭桥血管之一.     

协和医院完成6例全动脉化冠状动脉搭桥

协和医院完成６例全动脉化冠状动脉搭桥北京协和医院心脏外科连续为６例病人施行了全动脉冠状动脉搭桥手术，并取得成功。这标志着协和医院在冠状动脉搭桥手术领域已走在世界前列。我国目前仅有２０余家医院能开展冠状动脉搭桥术，其中少数医院搭桥在使用大隐静脉的同时，...     

冠状动脉搭桥术后CTA对桥血管的临床评价

目的：探讨冠状动脉搭桥术后CTA对桥血管的临床评价。方法收集2012年7月~2014年7月来我院进行冠状动脉旁路搭桥术的患者作为研究对象,共计90例。其中男性50例,女性40例,平均年龄(53.1±12.8)岁,冠状动脉旁路搭桥术后时间<4~5年。患者来我院就诊时表现为心绞痛、气短、活动后心悸等典型冠状动脉缺血表现。其中动脉桥44支,静脉桥115支。分别对所有研究对象进行冠状动脉旁路搭桥术CTA。评价冠状动脉旁路搭桥血管CTA图像(质量、血管狭窄率、板块显示情况),将冠状动脉造影图像与CTA图像中动脉桥血管和静脉桥血管显示率进行对比。结果所有研究对象均能完成检查,检查的过程中没有出现不良反应。其中1级图像的有55例,有12例二级图像质量,39例3级图像质量通过计算机重建后均满足诊断要求。静脉桥血管中闭塞28支,狭窄率为24.3%,见图1。动脉桥血管中闭塞7支,狭窄率为15.9%。血管钙化斑块12支,软斑8支,混合斑块5支。冠状动脉旁路搭桥血管CTA共检测出动脉桥血管为95.5%(42/44),静脉桥血管为98.3%(113/115),冠状动脉造影共检测出动脉桥血管为100%(44/44),静脉桥血管为100%(115/115),差异无统计学意义(>0.05)。结论我们认为冠状动脉旁路搭桥血管CTA能较好评估桥血管,操作简单,无不良反应,简便安全。     

桡动脉提取在高流量脑血管搭桥手术中的应用

目的　探讨桡动脉提取技术在高流量脑血管搭桥中的应用。 方法　回顾性纳入2015年1月至2021年6月天津市环湖医院32例以桡动脉为桥血管行高流量脑血管搭桥手术患者,统计桡动脉所取长度及内径、收缩期峰值流速、舒张末期流速、内膜厚度、阻力系数等相关参数,应用影像学及临床数据评估手术效果,术后桥血管通畅率及并发症等有效性、安全性指标。 结果　本组患者无围手术期死亡,32例患者共搭桥32根,所取桡动脉平均长度（20.20±2.06）cm,近心端内径平均（2.41±0.28）mm,远心端内径平均（2.28±0.42）mm,各项参数及Allen's试验、造影等检查提示所取桡动脉通畅性良好,满足高流量搭桥需要,本研究中提取桡动脉搭桥技术成功率100%,术后随访影像学检查示搭桥通畅,患者均未出现因桥血管痉挛而导致的缺血性卒中,前臂及腕关节肌力较术前未下降,4例患者出现前臂外侧皮神经及桡神经浅支损伤症状并于3月内缓解。 结论　提取桡动脉技术应用于脑血管搭桥具有安全性、有效性,该技术配合高流量脑血管搭桥术在颅底肿瘤、复杂脑血管疾病等领域具有广阔的应用前景。     

桡动脉与冠状动脉几何性状和显微结构成份的比较

目的：通过对桡动脉与冠状动脉几何性状和显微结构成份的比较研究，为桡动脉应用于冠状动脉搭桥术提供依据。方法：非心脏病死亡的尸体，在其桡动脉的上端、中点、下端及冠状动脉主干根部，横断取材制作切片，光镜下观察并用图像分析仪对其显微结构成份进行定量研究。结果：桡动脉的内、外径与冠状动脉的前室间支、旋支、右冠状动脉接近，但它的内膜面积和管腔狭窄率均明显低于冠状动脉。桡动脉与冠状动脉的显微结构成份相似；管壁平滑肌的含量二者无显著差异。结论：桡动脉是冠脉搭桥术可供选择的较理想的移植血管。     

上颌动脉显露技术在脑血管搭桥术中的应用

目的 观察上颌动脉翼状肌段的解剖特点,探讨上颌动脉显露技术在脑血管搭桥术中临床应用的可行性。方法 选取新鲜成人完整尸头标本12具,其中女3具、男9具,年龄50~80岁（平均64岁）。尸头标本经乳胶灌注后,采用翼点入路,切除颧弓,显露上颌动脉翼状肌段。观察记录两侧上颌动脉走行的特点、与翼外肌的位置关系,测量上颌动脉翼状肌段到颞下嵴的间距。 回顾性分析郑州大学第一附属医院神经外科2020年10月—2021年4月收治的2例脑血管搭桥患者的临床资料。男女各1例,年龄分别为62、38岁。1例患者诊断为基底动脉冗扩合并动脉瘤,一期行优势侧椎动脉介入闭塞术,二期行上颌动脉-桡动脉-小脑上动脉搭桥术;另1例患者诊断为脑梗死、前床突脑膜瘤、左侧颈内动脉末端重度狭窄,行上颌动脉-桡动脉-大脑中动脉搭桥术+脑膜瘤切除术。2例患者均经翼点入路、切除颧弓显露上颌动脉,完成血管搭桥手术。观察术后桥血管通畅情况,以及患者术后神经功能状态。结果 （1）尸头标本12具均成功暴露了两侧上颌动脉的翼状肌段,未发生颅神经损伤。上颌动脉经翼外肌外侧走行17侧,其翼状肌段到颞下嵴的长度为8.2~18.4（13.2±4.2）mm ;上颌动脉经翼外肌内侧走行7侧,其翼腭窝段均较短,无法上提至颞下嵴,故未记录其可游离长度。（2）2例患者均成功显露上颌动脉的翼状肌段,顺利完成脑血管搭桥手术。病例1患者,术后神经功能状态稳定;术后3个月复查头颅CT血管成像（CTA）,见桥血管通畅、基底动脉动脉瘤大小无明显变化。病例2术后左上肢肌力由术前2级下降至0级;术后3个月电话随访无再发脑缺血症状,患肢肌力恢复到4级,CTA显示桥血管闭塞。结论 翼点联合颧弓切除术可安全有效地显露上颌动脉翼状肌段。翼外肌外侧走行的上颌动脉相对长且表浅,是实施脑血管搭桥术的一种较好的供体血管。     

上颌动脉显露技术在脑血管搭桥术中的应用

目的观察上颌动脉翼状肌段的解剖特点, 探讨上颌动脉显露技术在脑血管搭桥术中临床应用的可行性。方法选取新鲜成人完整尸头标本12具, 其中女3具、男9具, 年龄50～80岁(平均64岁)。尸头标本经乳胶灌注后, 采用翼点入路, 切除颧弓, 显露上颌动脉翼状肌段。观察记录两侧上颌动脉走行的特点、与翼外肌的位置关系, 测量上颌动脉翼状肌段到颞下嵴的间距。回顾性分析郑州大学第一附属医院神经外科2020年10月—2021年4月收治的2例脑血管搭桥患者的临床资料。男女各1例, 年龄分别为62、38岁。1例患者诊断为基底动脉冗扩合并动脉瘤, 一期行优势侧椎动脉介入闭塞术, 二期行上颌动脉-桡动脉-小脑上动脉搭桥术;另1例患者诊断为脑梗死、前床突脑膜瘤、左侧颈内动脉末端重度狭窄, 行上颌动脉-桡动脉-大脑中动脉搭桥术+脑膜瘤切除术。2例患者均经翼点入路、切除颧弓显露上颌动脉, 完成血管搭桥手术。观察术后桥血管通畅情况, 以及患者术后神经功能状态。结果 (1)尸头标本12具均成功暴露了两侧上颌动脉的翼状肌段, 未发生颅神经损伤。上颌动脉经翼外肌外侧走行17侧, 其翼状肌段到颞下嵴的长度为8.2～18.4(...     

人类生长因子诱导缺血性心肌的血管生成:一种冠心病治疗新方法的首次临床报告

该研究旨在评价动物实验中血管生长因子生物学效应以及人类生长因子 (HGF)治疗冠心病的潜在疗效。研究涉及 1通过基因工程对 HGF的提取、分离、定性及纯化。 2应用动物实验证实 HGF的新生血管作用 ,以及排除任何可能的致病作用。 3临床应用碱性成纤维细胞生长因子 (FGF-I)作为冠脉搭桥术后的辅助治疗并证实其新生血管作用。方法与结果　选择 2 0例患冠状动脉多支病变的患者接受研究 (男性 14例 ,女性 6例 ) ,最小年龄 5 0岁 ,均无心肌梗塞和手术史。FGF- I将在搭桥手术中使用。另选 2 0例情况相同的患者作为对照组。两组患者在临床症…     

超声手术刀切取用于CABG的胸内动脉

据ＨｉｇａｍｉＴ(ＡｎｎＴｈｏｒａｃＳｕｒｇ ,2 0 0 1,71,12 2 4 - 12 2 8)报道 ,采用超声手术刀切取用于冠状动脉搭桥术 (ＣＡＢＧ)的胸内动脉效果较好。用超声手术刀切取胸内动脉 (ＩＴＡ) ,做了 2 0 0例病人冠状动脉移植手术。其中 188例在术后 1个月内做了血管造影。结果发现超声手术刀切取的血管与常规方法切取带蒂ＩＴＡ相比有效长度多 4ｃｍ ,血管内血流量高出 3 0 % ;术后血管造影测定 ,早期开放率ＩＴＡｓ左支为 99 7% ,而右支为 10 0 % ,无一例病人需要术后介入或再次手术。该法较切取带蒂ＩＴＡ安全、创伤小 ,是采取胸内动脉…     

Elective vs non-elective radial artery grafts: comparing midterm results through 64-Slice computed tomography

BACKGROUND: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of the coronary artery bypass graft procedure (CABG). This grafting in turn has led to an increased use of other arterial conduits, of which the radial artery (RA) is most popular. Whether RA grafting can be used in the emergency patient is controversial. METHODS: 47 patients with critical stenosis (>70%) in all target vessels underwent CABG with LITA and RA grafts from 1996 to 2003. Patients were divided into elective (23 patients) and non-elective groups (24 patients) with LITA and RA grafts per patient being similar in both groups. Of these 47 patients, 5 died from non-cardiac complications and 12 were unavailable. Thus, 30 patients (71% of survivors) were studied by multidetector computed tomography. A total of 36 LITA and 64 RA grafts were studied. RESULTS: The RA patency rate for elective and non-elective grafts were 82% (31/38) and 85% (22/26), respectively (p=0.75). The RA had a similar patency rate for all target vessels ranging from 73% to 100%. Only one patient had a redo CABG and 29 (97%) are free from angina or re-intervention. LITA-LADA had a 92% (11/12) and 100% (10/10) patency rate for elective and non-elective groups, respectively (p=0.37). The sequential LITA-diagonal-LADA in the elective group had a 50% (03/06) patency rate, which was significantly lower than the 100% (08/08) patency rate of the non-elective group (p=0.02). CONCLUSION: Radial Artery grafts can be used in both elective and non-elective patients with excellent results.     

The impact of the preoperative severity of target-vessel stenosis on the short-term patency of radial artery grafts

The fate of a grafted radial artery remains unknown. The purpose of this study was to determine whether the preoperative severity of stenosis of the target vessel influence short-term patency of radial artery (RA) grafts used as coronary artery bypass conduits. In 54 patients who had coronary artery bypass grafting (CABG) with RA grafts, RA patency was determined with multi-slice computed tomography (MSCT) 1 year after CABG. These patients were divided into three groups on the basis of the percentage of the target vessel stenosis: mild (< 60%, n=17), moderate (60% to 79%, n=19), and severe (>/= 80%, n=18). MSCT was also performed 1 week later to exclude early occlusion of RA grafts. In 3 patients, the MSCT failed to adequately discriminate the status of the RA graft due to poor image resolution. The overall incidence of RA occlusion was 23.5% (12 of 51) at 1 year in the entire population. The mild stenosis, moderate stenosis and severe stenosis group showed an occlusion rate of 50% (8 of 16), 23.5% (4 of 17) and 0% (0 of 18), respectively. The severe stenosis group had significantly lower rate of RA graft occlusion compared to the mild stenosis group (p < 0.001) and moderate stenosis group (p < 0.05). No difference in occlusion between grafts used for the different coronary artery branches could be demonstrated. Preoperative severity of the target coronary artery significantly affected the short-term RA grafts patency. Correct indication is the key factor for short-term RA patency.     

桡动脉在冠状动脉旁路术中的应用解剖学研究

目的：为应用桡动脉作冠状动脉旁路术(coronary artery bypass grafting，CABG)的动脉桥提供解剖学依据。方法：观测了35具成人尸体的两侧桡动脉长度、外径、毗邻结构和可用于CABG的长度和外径。结果：桡动脉总长度为20．87cm，可用于CABG的长度为19．99cm；桡动脉上端外径为3．18mm，可用于CABG的桡动脉上端、中点、下端外径分别是2．66mm、2．28mm、2．29mm。结论：桡动脉有足够的长度和与冠状动脉相匹配的外径，可作为CABG的动脉桥。     

Anatomical variants of the lateral femoral circumflex artery: an angiographic study

The descending branch of the lateral femoral circumflex artery (LFCA) has found recent use as a new arterial graft for coronary artery bypass grafting (CABG). Anatomical variants of the LFCA were assessed on femoral arteriograms obtained before CABG in 131 adult patients. The most common pattern, found in 78.6% of extremities, consisted of the LFCA arising from the deep femoral artery, and the arterial graft was selected from this pattern in 92.3% of patients in whom the descending branch of the LFCA was used for CABG.     

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Introduction

We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD).

Material and methods

A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE).

Results

Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group.

Conclusions

The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.     

组织型纤溶酶原激活剂在移植血管桥再狭窄动物血管的差异表达

目的研究组织型纤溶酶原激活剂（t—PA／PLAT）在移植血管桥再狭窄动物血管的差异表达。方法通过兔双侧颈动脉进行动脉桥和静脉桥的移植,形成双侧移植血管桥再狭窄动物模型。应用免疫组化检测t-PA在动物模型动脉桥、静脉桥的表达并进行比较。结果血管桥移植前,t-PA在实验动物颈动脉和颈静脉的表达差异无统计学意义（P〉0．05）;血管桥移植后,t-PA在动脉桥的表达明显高于静脉桥（P〈0．05）,于16周时达到高峰[（32．34±4．74）％比（16．74±3．14）％],以后随时间延长而出现表达减少（P〈0．05）。结论t-PA在术后早期对血管桥具有保护作用,其表达的高低与术后血管桥再狭窄关系密切。     

Uterine artery as an arterial conduit for coronary artery bypass graft (CABG) surgery in women: A role for estrogen-receptor alpha (ER-α) in the prevention of post-CABG accelerated atherosclerosis and graft disease

Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease (CAD). In order to bypass coronary occlusions, CABG surgery traditionally employs grafts from the left internal thoracic/mammary artery (LITA/IMA), radial artery (RA), and greater saphenous vein (SV). The risk of CABG failure is reported to be higher, or at best similar, for women than for men, and it relates primarily to post-operative accelerated atherosclerosis leading to graft stenosis and recurrent angina, a phenomenon known as “coronary artery bypass graft disease”. In this paper, the authors hypothesize that employing an alternative arterial conduit may help reduce the rate of post-CABG accelerated atherosclerosis in women, and propose that a uterine artery specimen be used instead. Given its greater density of estrogen-receptor alpha (ER-α) relative to other mammalian endothelial cells in the vasculature, uterine arteries may exhibit important anti-atherosclerotic properties. Theoretically, this effect may be amplified with the adjuvant administration of low-dose selective ER-α agonist modulator (SERM) therapy.     

The descending branch of the lateral circumflex femoral artery as an alternative conduit for coronary artery bypass grafting: Experience from an anatomical,radiological and histological study

The descending branch of the lateral circumflex femoral artery (DBLCFA) has been suggested as an option for use in coronary artery bypass grafting (CABG). Our aim was to combine radiological examination, surgical and anatomical preparation, and histological assessment of the DBLCFA to map its variability and to assess the benefits of this conduit in cardiac surgery. The pelvic and femoral arteries were examined by CT angiography (CTA) in 100 patients (aged 68.3 ± 9.3 years) to assess the variability of the DBLCFA. Anatomical dissections were performed on 20 cadavers. In 15 patients, an autologous DBLCFA was implanted during CABG. In 35 samples, possible atherosclerotic lesions were examined histologically. The length of the potential DBLCFA conduits measured by CTA was 9.3 ± 2.9 cm, without correlating with the length of the thigh. Anatomical variations that would prevent the DBLCFA from being used in CABG were found in 27 out of 100 patients. Except for focal thickening of the intima, eccentric hypertrophy of the intima was found in three out of 35 samples. No inflammatory infiltration, foam cells, atheroma, or calcifications were found histologically. The DBLCFA is not to be used routinely or in preference to other grafts of choice. However, owing to its moderate variability, sufficient length, caliber, and rare atherosclerosis, it can be used in the absence of other suitable grafts as an alternative conduit implanted as a composite Y‐graft end‐to‐side to the internal thoracic artery in patients without diabetic angiopathy, neuropathy or peripheral artery disease who are undergoing extensive or repeat coronary revascularization. Clin. Anat. 29:779–788, 2016. © 2016 Wiley Periodicals, Inc.     

Long-term outcomes of percutaneous coronary interventions within coronary artery bypass grafts

IntroductionThe long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses.Material and methodsWe enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection.ResultsThe primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses (p < 0.01), post-dilatation (p < 0.05) and no-reflow (p < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed.ConclusionsPercutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.     

冠状动脉旁路移植治疗冠状动脉肌桥9例分析

目的回顾冠状动脉旁路移植术治疗症状性肌桥的外科治疗经验及结果。方法选取2004年3月至2011年1月因冠状动脉肌桥导致冠状幼脉血流堵塞需行冠状动脉旁路移植术的患者资料9例,采用胸廊内动脉到前降支进行旁路移植,2例取大隐静脉与其他病变冠状动脉进行旁路移植。结果全组无患者死亡,无术中相关并发症发生。所有患者随访4个月至7年,临床症状均明显改善,无心绞痛发生,无心肌梗死及其他主要心血管不良事件（再血管化或死亡等）发生。结论冠状动脉旁路移植治疗有症状的肌桥安全、有效。