Ali Erden, Saso Srdjan, Ahmed Kamran, Athanasiou Thanos
Department of Biosurgery-Surgical Technology and Surgical Epidemiology Unit, Imperial College London, 10th Floor, QEQM building, Imperial College Healthcare NHS Trust at St Mary's Hospital, Praed Street, London W2 1NY, UK.
Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):289-92. doi: 10.1510/icvts.2009.221101. Epub 2009 Nov 11.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether skeletonization of the radial artery (RA) improves conduit patency in coronary artery bypass grafting (CABG). Altogether 15 papers were found using the reported search, of which four papers represented the best evidence to answer the clinical question. Two papers compared patency rates between skeletonized and pedicled radial arteries. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We acknowledge that evidence is limited in this area of cardiac surgery. When assessing the skeletonized RA, three studies provided patency data one year after CABG. No patency data were available five years after CABG. Only two papers were comparative studies (skeletonized conduits vs. pedicled conduits). Despite the above, short- and medium-term patency rates of skeletonized conduits are excellent. In the two comparative studies, patency of skeletonized vessels was superior to the pedicled conduits. Patency was assessed with the use of angiography and rates exceeded 95% in all four studies. Overall patency rates were 100% within 18 days, 98.3% within three months, 97.6% at a mean of approximately 1 year, and 100% at 4 years in one study. From these studies, we can conclude that the patency rates of pedicled conduits are excellent, however, our study suggests that skeletonization may offer the radial conduit some patency benefit when compared to the pedicled technique. The remaining two non-comparative studies support the above conclusion.
根据结构化方案撰写了一篇心脏外科的最佳证据主题。所探讨的问题是，在冠状动脉旁路移植术（CABG）中，桡动脉（RA）骨骼化是否能提高血管桥通畅率。通过报告的检索共找到15篇论文，其中4篇论文代表了回答该临床问题的最佳证据。两篇论文比较了骨骼化桡动脉和带蒂桡动脉的通畅率。现将作者、期刊、出版日期和国家、所研究的患者组、研究类型、相关结局和结果制成表格。我们承认，心脏外科这一领域的证据有限。在评估骨骼化桡动脉时，三项研究提供了CABG术后一年的通畅数据。CABG术后五年没有通畅数据。只有两篇论文是比较研究（骨骼化血管桥与带蒂血管桥）。尽管如此，骨骼化血管桥的短期和中期通畅率都非常出色。在两项比较研究中，骨骼化血管的通畅率优于带蒂血管桥。通过血管造影评估通畅率，所有四项研究中的通畅率均超过95%。在一项研究中，总体通畅率在18天内为100%，三个月内为98.3%，平均约一年时为97.6%，四年时为100%。从这些研究中，我们可以得出结论，带蒂血管桥的通畅率非常出色，然而，我们的研究表明，与带蒂技术相比骨骼化可能会给桡动脉血管桥带来一些通畅方面的益处。其余两项非比较性研究支持上述结论。
