Tamura Yamato, Okiyama M, Tsuda T, Toyama M
Department of Cardiovascular Surgery, Okinawa-Kyodo Hospital, Okinawa, Japan.
Kyobu Geka. 2003 Nov;56(12):997-1001.
A 52-year-old man with hemodialysis had undergone coronary artery bypass grafting (CABG); left internal thoracic artery (LITA) to left anterior descending artery (LAD), right gastroepiploic artery (RGEA) to posterolateral branch (PL), saphenous vein graft (SVG) to diagonal artery (Dx) 5 years previously. After 3 years, angiography was performed due to recurrence of angina pectoris and revealed RGEA and SVG was totally occluded. Since repeated intervention was unsuccessful, reoperation was necessary. Therefore, we performed re-do CABG without cardiopulmonary bypass using lateral femoral circumflex artery (LFCA) as an arterial conduit for myocardial revascularization via the 6th left intercostal posterolateral thoracotomy. Postoperative angiography showed that the LFCA bypass graft was patent and supplied sufficient blood to anastomosed vessel. The patient has had no angina pectoris subsequently. We believe this procedure is useful for re-do myocardial revascularization, and LFCA deserves to be taken into account as an alternative graft in a patient with chronic hemodialysis.
一名52岁接受血液透析的男性曾接受冠状动脉旁路移植术（CABG）；5年前，左乳内动脉（LITA）至左前降支动脉（LAD），右胃网膜动脉（RGEA）至后外侧支（PL），大隐静脉移植血管（SVG）至对角动脉（Dx）。3年后，因心绞痛复发进行血管造影，显示RGEA和SVG完全闭塞。由于重复干预未成功，需要再次手术。因此，我们通过左第6肋间后外侧开胸术，使用旋股外侧动脉（LFCA）作为动脉管道，在非体外循环下进行再次CABG，以实现心肌血运重建。术后血管造影显示，LFCA旁路移植血管通畅，为吻合血管提供了充足的血液。该患者随后未再出现心绞痛。我们认为此手术对再次心肌血运重建有用，并且在慢性血液透析患者中，LFCA值得作为替代移植血管予以考虑。
