Seki T, Kitamura S, Kawachi K, Morita R, Kawata T, Mizuguchi K, Hasegawa J, Kameda Y, Yoshida Y
Department of Surgery III, Nara Medical College, Japan.
J Thorac Cardiovasc Surg. 1992 Dec;104(6):1532-8.
We used quantitative angiography to determine the postoperative diameter of the internal thoracic artery graft at the point close to the anastomosed site in 147 patients who received the graft for the left anterior descending coronary artery. We performed generalized multiple linear regression analysis (Type I quantification method) to assess the effects of the following factors on the internal thoracic artery graft diameter: age, gender, time of angiography, laterality of the internal thoracic artery used, presence of an undivided major side branch of the internal thoracic artery, presence of a saphenous vein graft having blood flow competition with an internal thoracic artery graft, presence of distal stenosis of the recipient left anterior descending coronary artery, severity of postoperative left anterior descending coronary artery stenosis, and presence of coronary risk factors. The standardized category scores for 25% left anterior descending coronary artery stenosis, 50% left anterior descending coronary artery stenosis, and presence of a saphenous vein graft having blood flow competition with an internal thoracic artery graft were -1.418, -0.767 and -0.622, respectively. Thus, the internal thoracic artery diameter was smaller in patients with well-preserved flow of the recipient coronary artery. The internal thoracic artery diameter had a particularly strong correlation with the degree of left anterior descending coronary artery stenosis (partial correlation coefficient: 0.670). The other factors seemed to have little or no correlation with the postoperative internal thoracic artery diameter. With the criterion that the internal thoracic artery diameter below 1.0 mm represents the "string sign" of internal thoracic artery graft, this phenomenon was observed in nine patients (6.1%). In all of these patients, left anterior descending coronary artery flow was well-preserved, and no ischemia was disclosed in the left anterior descending coronary artery-perfused area. These results indicate that internal thoracic artery grafts have flow adaptability responding to the flow demand of the recipient coronary artery and that the string sign of internal thoracic artery grafts is mainly an outcome of its physiologic characteristics.
我们采用定量血管造影术测定了147例接受左前降支冠状动脉搭桥术患者的胸廓内动脉移植物在靠近吻合部位处的术后直径。我们进行了广义多元线性回归分析（I型量化方法），以评估以下因素对胸廓内动脉移植物直径的影响：年龄、性别、血管造影时间、所使用胸廓内动脉的侧别、胸廓内动脉未分支主要侧支的存在情况、与胸廓内动脉移植物存在血流竞争的大隐静脉移植物的存在情况、受体左前降支冠状动脉远端狭窄的存在情况、术后左前降支冠状动脉狭窄的严重程度以及冠状动脉危险因素的存在情况。左前降支冠状动脉狭窄25%、左前降支冠状动脉狭窄50%以及与胸廓内动脉移植物存在血流竞争的大隐静脉移植物的存在情况的标准化类别分数分别为-1.418、-0.767和-0.622。因此，受体冠状动脉血流保存良好的患者，其胸廓内动脉直径较小。胸廓内动脉直径与左前降支冠状动脉狭窄程度具有特别强的相关性（偏相关系数：0.670）。其他因素似乎与术后胸廓内动脉直径几乎没有或没有相关性。以胸廓内动脉直径低于1.0 mm代表胸廓内动脉移植物的“细绳征”为标准，在9例患者（6.1%）中观察到了这种现象。在所有这些患者中，左前降支冠状动脉血流保存良好，且左前降支冠状动脉灌注区域未发现缺血。这些结果表明，胸廓内动脉移植物具有适应受体冠状动脉血流需求的血流适应性，且胸廓内动脉移植物的细绳征主要是其生理特征的结果。
