Bauer E P, Bino M C, von Segesser L K, Laske A, Turina M I
Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
Thorac Cardiovasc Surg. 1990 Oct;38(5):312-5. doi: 10.1055/s-2007-1014041.
The internal mammary arteries (IMA) are considered to be the superior conduit in coronary bypass grafting (CABG). Anomalies of an IMA can influence the surgical technique and results; their true incidence is not well known. The IMA's were visualised angiographically in 262 consecutive patients undergoing cardiac catheterisation prior to CABG. Satisfactory visualisation was possible of 459/524 IMA's studied (88%). A total of 118/459 (26%) surgically significant anomalies was observed in 79/262 patients (30%): common origin of another large artery in 48/459 (11%), large side branches in 41/459 (9%), tortuosity in 21/459 (5%), atypical course or origin in 5/459 (1%), atherosclerotic lesions in 2/459 (0.4%) and spasticity of an IMA in 1/459 (0.2%). Angiographic visualisation of the IMA's resulted in modification of surgical strategy in 11/262 patients (4%); meticulous preparation because of difficult or atypical IMA anatomy was necessary in 68/262 patients (26%). These results demonstrate that significant anomalies of the IMA which might--when unrecognized--jeopardize IMA-flow after CABG are relatively common; they might escape detection during IMA take-down but can be diagnosed by angiography during catheterisation.
乳内动脉（IMA）被认为是冠状动脉旁路移植术（CABG）中理想的血管桥。IMA异常会影响手术技术和效果，但其实际发生率尚不清楚。对262例连续接受CABG术前心脏导管检查的患者进行了IMA血管造影。在所研究的524支IMA中，459支（88%）实现了满意的显影。在79/262例患者（30%）中观察到118/459支（26%）具有手术意义的异常：48/459支（11%）与另一大动脉共干，41/459支（9%）有粗大分支，21/459支（5%）迂曲，5/459支（1%）走行或起源异常，2/459支（0.4%）有动脉粥样硬化病变，1/459支（0.2%）IMA痉挛。IMA血管造影使11/262例患者（4%）的手术策略得以调整；68/262例患者（26%）因IMA解剖结构困难或异常而需要精心准备。这些结果表明，CABG术后若未识别出可能危及IMA血流的IMA重大异常相对常见；它们在IMA游离时可能未被发现，但可在导管检查时通过血管造影诊断。
