Massey Rachel M, Warren Oliver J, Szczeklik Michal, Wallace Sophie, Leff Daniel R, Kokotsakis John, Darzi Ara, Athanasiou Thanos
Department of BioSurgery and Surgical Technology, Imperial College London, 10th Floor QEQM Wing, St, Mary's Hospital, Praed Street, London, W2 1NY, UK.
J Cardiothorac Surg. 2007 Jun 5;2:26. doi: 10.1186/1749-8090-2-26.
The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.
在冠状动脉搭桥手术中，使用骨骼化胸廓内动脉已被证明比传统的带蒂技术具有某些优势，特别是在某些患者群体中。最近的报告表明，桡动脉和胃网膜动脉也可以采用骨骼化技术获取。本研究的目的是系统评价冠状动脉搭桥手术中使用骨骼化桡动脉和胃网膜动脉的现有证据，特别关注其对血管桥长度和血流、内皮损伤程度、移植物通畅率和临床结局的影响。系统检索了四个电子数据库，以查找报告在人类冠状动脉血运重建手术中使用骨骼化技术的研究。检查所有已识别研究的参考文献列表，以查找任何遗漏的出版物。与带蒂血管相比，似乎有一些证据表明，在短期至中期，骨骼化可能会改善血管造影的通畅率。我们没有发现并发症发生率增加或手术时间延长的迹象。骨骼化可能会增加血管桥的长度和序贯移植部位的数量，但没有明显的临床益处。我们的研究表明，目前没有足够高质量或一致的证据支持在传统带蒂技术之前将该技术应用于桡动脉或胃网膜血管桥。
