Souza Domingos S R, Johansson Benny, Bojö Leif, Karlsson Roland, Geijer Håkan, Filbey Derek, Bodin Lennart, Arbeus Mikael, Dashwood Michael R
Department of Cardiothoracic Surgery and Anesthesiology, Orebro University Hospital, SE-701 85 Orebro, Sweden.
J Thorac Cardiovasc Surg. 2006 Aug;132(2):373-8. doi: 10.1016/j.jtcvs.2006.04.002.
Conventional harvesting of the saphenous vein in coronary artery bypass surgery produces vessel damage that contributes to graft failure. A novel "no touch" technique provides high short- and long-term patency rates.
This randomized longitudinal trial compares graft patency of two patient groups undergoing coronary artery bypass surgery. Conventional: 52 patients had their veins stripped, distended, and stored in saline solution. No-touch: 52 patients had veins removed with surrounding tissue, not distended, and stored in heparinized blood. Angiographic assessment was performed at mean time 18 months after the operation in 46 patients in the conventional group and 45 patients in the no-touch group and repeated at mean time 8.5 years in 37 patients from both groups.
The distribution of the grafts to the recipient coronary arteries regarding their size and quality was similar in both groups. The angiographic assessment at 18 months postoperatively showed 89% conventional versus 95% no-touch grafts were patent. Repeated angiography at 8.5 years showed a patency rate for the conventional group of 76% and 90% for the no-touch group (P = .01). The multivariate analysis showed that the most important surgical factors for graft patency were the technique of harvesting (odds ratio= 3.7, P = .007) for the no-touch versus the conventional technique and the vein quality before implantation (odds ratio = 3.2, P = .007) for veins that were of good quality. By comparison the patency of the thoracic artery grafts was 90%.
Harvesting the saphenous vein with surrounding tissue provides high short- and long-term patency rates comparable to the left internal thoracic artery.
冠状动脉搭桥手术中传统的大隐静脉采集方法会造成血管损伤，这是导致移植血管失败的原因之一。一种新型的“非接触式”技术可实现较高的短期和长期通畅率。
这项随机纵向试验比较了两组接受冠状动脉搭桥手术患者的移植血管通畅情况。传统组：52例患者的静脉被剥离、扩张并储存在盐溶液中。非接触组：52例患者的静脉与周围组织一起被移除，未进行扩张，并储存在肝素化血液中。对传统组的46例患者和非接触组的45例患者在术后平均18个月时进行血管造影评估，并在两组的37例患者术后平均8.5年时重复进行评估。
两组中移植到受体冠状动脉的移植物在大小和质量方面的分布相似。术后18个月的血管造影评估显示，传统组移植物通畅率为89%，非接触组为95%。在8.5年时重复进行血管造影显示，传统组的通畅率为76%，非接触组为90%（P = 0.01）。多因素分析表明，对于移植物通畅来说，最重要的手术因素是采集技术（非接触技术与传统技术相比，优势比 = 3.7，P = 0.007）以及植入前静脉的质量（质量良好的静脉，优势比 = 3.2，P = 0.007）。相比之下，胸廓内动脉移植物的通畅率为90%。
采集带有周围组织的大隐静脉可实现较高的短期和长期通畅率，与左胸廓内动脉相当。
