Chiu Kuan-Ming, Li Shao-Jung, Chen Jer-Shen, Lin Tzu-Yu, Chan Chih-Yang, Chu Shu-Hsun
Department of Cardiovascular Surgery, Far-Eastern Memorial Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2006 May;105(5):384-9. doi: 10.1016/S0929-6646(09)60134-0.
BACKGROUND/PURPOSE: Coronary artery bypass grafting (CABG) provides better long-term patency than percutaneous intervention in patients with significant coronary artery disease. The radial artery is the second most common arterial conduit used for CABG in Western countries. However, radial artery harvesting necessitates a large surgical wound and has gained few patients' acceptance in subtropical areas. This study investigated the use of the minimally invasive approach of endoscopic radial artery harvest for CABG, and the surgical results at the harvest site.
An endoscopic harvest program for radial arteries was implemented in this hospital in September 2003. During the first 12 months of the program until September 2004, 122 patients underwent the procedure. Preoperative evaluation included Allen's test and the modified palmar arch perfusion test. The age of patients ranged from 32 to 88 years old. Patients were excluded from participation if they had undergone recent transradial catheterization, had end-stage renal disease or documented peripheral artery occlusive disease. The VasoView system was utilized for the procedure. Details of the surgical techniques used were recorded and analyzed.
Using the endoscopic technique, 122 radial arteries were harvested successfully. The mean resting length of the harvested radial artery was 15.7 cm. No obvious arterial injury was visually confirmed. All radial arteries were used for CABG, except for two which were noted to have atherosclerotic plaques causing stenoses. Forty-seven patients presented with mild numbness over the dorsum of the thumb base, which improved significantly during the 3-month follow-up. No arterial insufficiency in the forearms or hands was noted.
Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.
背景/目的：对于患有严重冠状动脉疾病的患者，冠状动脉旁路移植术（CABG）比经皮介入治疗具有更好的长期通畅率。桡动脉是西方国家CABG中第二常用的动脉血管。然而，获取桡动脉需要较大的手术切口，在亚热带地区很少被患者接受。本研究调查了用于CABG的内镜下微创获取桡动脉的方法以及获取部位的手术结果。
2003年9月本院实施了内镜下获取桡动脉的方案。在该方案实施的前12个月直至2004年9月，122例患者接受了该手术。术前评估包括艾伦试验和改良掌弓灌注试验。患者年龄在32岁至88岁之间。近期接受过桡动脉导管插入术、患有终末期肾病或有记录的外周动脉闭塞性疾病的患者被排除在研究之外。手术使用了VasoView系统。记录并分析了所采用手术技术的详细情况。
使用内镜技术成功获取了122条桡动脉。所获取桡动脉的平均静息长度为15.7厘米。未肉眼确认有明显的动脉损伤。除两条发现有动脉粥样硬化斑块导致狭窄外，所有桡动脉均用于CABG。47例患者拇指根部背侧出现轻度麻木，在3个月的随访期间有明显改善。未发现前臂或手部动脉供血不足。
内镜下获取桡动脉技术要求较高，但可取得良好效果。与开放获取技术相比，内镜入路能以侵入性较小的方式提供合适的血管。
