Vural K M, Sener E, Taşdemir O
Cardiovascular Surgery Department, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
Eur J Cardiothorac Surg. 2001 Feb;19(2):140-4. doi: 10.1016/s1010-7940(00)00629-1.
The long-term patency rates for individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits are angiographically compared; the impact of native coronary vessel characteristics is investigated.
A total of 875 distal coronary anastomoses on 500 SVGs were assessed in 430 patients at an average of 5.8+/-3 years after a coronary revascularization procedure.
The patency rates of sequential conduits were markedly higher than those of individual ones (82 vs. 68%, P=0.0005). Also, the anastomoses on the sequential conduits had better patency (75 vs. 68%, P=0.03). This difference was even more pronounced in coronary arteries of poor quality and small (<1.5 mm) diameter (57 vs. 28% for the sequential grafts and individual grafts, respectively, P=0.001). Also, when the most distally located coronary artery on a sequential graft was of poor run-off, the patency rate for the entire conduit was considerably low (42.5%).
The patency of a sequential vein graft conduit is generally better than that of an individual one, especially for poor run-off coronary vessels, provided that the most distally located anastomosis is done on a good coronary artery in terms of quality and diameter. Using a minimal length of conduits is another advantage. However, failure of a single sequential conduit jeopardizes all the anastomoses along that graft segment. Besides, sequential grafting is technically more demanding, and the technical expertise in performing a sequential anastomosis is probably among the important determinants of short- and long-term patency.
通过血管造影术比较单独和序贯大隐静脉移植物（SVG）作为冠状动脉旁路移植血管的长期通畅率；研究自身冠状动脉血管特征的影响。
在430例患者中，对500条SVG上的875个冠状动脉远端吻合口进行了评估，这些患者在冠状动脉血运重建术后平均5.8±3年。
序贯移植物的通畅率明显高于单独移植物（82%对68%，P=0.0005）。此外，序贯移植物上的吻合口通畅性更好（75%对68%，P=0.03）。这种差异在质量差和直径小（<1.5mm）的冠状动脉中更为明显（序贯移植物和单独移植物分别为57%对28%，P=0.001）。而且，当序贯移植物上最远端的冠状动脉血流不佳时，整个移植物的通畅率相当低（42.5%）。
序贯静脉移植物的通畅性一般优于单独移植物，尤其是对于血流不佳的冠状动脉血管，前提是最远端的吻合是在质量和直径方面良好的冠状动脉上进行。使用最短长度的移植物是另一个优点。然而，单个序贯移植物的失败会危及该移植物段上的所有吻合口。此外，序贯移植在技术上要求更高，进行序贯吻合的技术专长可能是短期和长期通畅性重要决定因素之一。
