冠状动脉移植术后患者桥血管通畅情况观察

目的 探讨冠状动脉移植术后患者桥血管通畅情况，为临床桥血管的选择提供参考。方法 回顾性分析32例冠状动脉移植术后复查冠脉造影患者的临床资料，分析大隐静脉（SVG）、左乳内动脉（LIMA）及桡动脉（RA）作为桥血管的整体使用情况及通畅情况，比较3种桥血管的近期（＜5年）、中期（5~10年）及远期（＞10年）通畅情况，并对RA闭塞情况进行分析。结果 32例患者桥血管使用总支数为85支，仅有1例用的右乳内动脉（RIMA），其他为SVG、LIMA、RA，使用支数分别为48、23、13支，4种桥血管整体通畅率为45.88%（39/85），SVG、LIMA、RA桥血管通畅率分别为 25%（12/48）、73.91%（17/23）、69.23（9/13）。所有桥血管的近期、中期及远期的通畅率呈降低趋势，其中LIMA、RA及SVG近期通畅率差异无统计学意义，LIMA和SVG中期通畅率高于RA，而RA的远期通畅率高于LIMA及SVG，但差异亦无统计学意义。9例RA通畅病例靶血管吻合口近段有严重狭窄（＞90%）或闭塞，远端血流通畅。结论 桡动脉整体使用率仍偏低，整体通畅率优于大隐静脉，可作为第二优选桥血管。桡动脉应用前需做好病人选择及桡动脉评估，靶血管吻合口近端狭窄程度显著影响桡动脉桥血管远期通畅率。

Observation on patency of radial artery bridge in patients after coronary artery transplantation

Objective To explore the patency of bridge vessels in patients after coronary artery transplantation, and toprovide reference for the selection of clinical bridge vessels. Methods Data of 32 patients underwent coronary angiographyafter coronary artery bypass grafting were selected and analyzed retrospectively. The overall usage and patency of the greatsaphenous vein graft (SVG), the left internal mammary artery (LIMA) and the radial artery (RA) were analyzed. The patencyof the near future (5 years), the medium term (5-10 years) and long term (>10 years) were compared between the three kindsof bridging vascular vessels. The RA occlusion was analyzed. Results The total number of bridge vessels used in 32patients was 85, only 1 case used right internal mammary artery (RIMA), the others used SVG, LIMA and RA, in which 48,23 and 13 branches were used respectively. The patency rates of SVG, LIMA and RA were 25% (12/48), 73.91% (17/23) and69.23(9/13) respectively. The recent and medium-term patency rates of all bridge vessels showed a decreasing trend, inwhich the recent patency rate of SVG was significantly higher than that in LIMA, the intermediate patency rates of LIMA andSVG were higher than that of RA, and the long-term patency rate of RA was significantly higher than that of LIMA and SVG.There was severe stenosis (＞90%) or occlusion in the proximal segment of anastomosis in the 9 radial arteries unobstructed.Conclusion The utilization rate of RA is still low, and the overall patency rate of RA is superior to the SVG. RA can beused as the second optimal bridge vessel. The patient selection and RA evaluation should be done before applying RA.Theproximal stenosis degree of target vessel significantly affects the long-term patency of RA.