Suma H
Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, 1202-1 Yamazaki, Kamakura, Kanagawa 247-8533, USA.
Ann Thorac Cardiovasc Surg. 1999 Jun;5(3):141-5.
During the last three decades, coronary artery bypass grafting (CABG) emerged, was developed and has progressed. The search for suitable conduits has been investigated aggressively and several venous, arterial and artificial grafts have been utilized clinically. It is clear now that the saphenous vein graft deteriorates with time and the occlusion rate reaches up to 50% at 10 years after CABG mainly due to atherosclerosis in the graft called "vein graft disease." The internal thoracic artery (ITA) graft, on the contrary, has very good long-term patency and this evidence directly relates to the superior outcome in terms of longevity and postoperative cardiac events in the long run. Based on this evidence, the use of arterial conduits for myocardial revascularization has been extended. Several autologous arteries have been investigated and utilized clinically such as the right gastroepiploic artery, the inferior epigastric artery, and the radial artery. With proper use of these new arterial conduits in addition to ITA, higher quality CABG can be performed safely, and a better long-term result can be expected.
在过去三十年中，冠状动脉旁路移植术（CABG）应运而生，并不断发展进步。人们积极探索合适的移植血管，多种静脉、动脉及人工移植血管已应用于临床。目前已明确，大隐静脉移植血管会随时间推移而退化，在冠状动脉旁路移植术后10年，其闭塞率高达50%，主要原因是移植血管内发生动脉粥样硬化，即所谓的“静脉移植血管病变”。相反，胸廓内动脉（ITA）移植血管具有很好的长期通畅率，这一证据直接表明从长远来看，在寿命和术后心脏事件方面能带来更好的结果。基于这一证据，用于心肌血运重建的动脉移植血管的应用得到了推广。多种自体动脉已被研究并应用于临床，如胃网膜右动脉、腹壁下动脉和桡动脉。除胸廓内动脉外，合理使用这些新型动脉移植血管，能够安全地实施更高质量的冠状动脉旁路移植术，并有望获得更好的长期效果。
