Dorros G, Lewin R F, Mathiak L
Department of Cardiology, St. Luke's Medical Center, Milwaukee, Wisconsin.
Clin Cardiol. 1990 Jun;13(6):403-8. doi: 10.1002/clc.4960130607.
Angioplasty (PTCA) was successfully performed in 257 of 304 patients (85%) greater than or equal to 5 years after their last bypass surgery. A lesion was successfully dilated in 496 of 566 vessels attempted (88%): 332/386 coronary arteries (86%) and 164/180 vein grafts (91%). Significant complications included: 8 (2.6%) mortalities, 4 (1.3%) emergency surgeries, 13 (4.3%) Q-wave myocardial infarctions, and 14 (4.6%) distal embolizations. Distal embolization occurred in 13/180 (7%) vein graft lesions dilated and usually resulted in a non-Q-wave infarction (4/13 distal embolizations). A second PTCA was performed on 89 (35%) patients: 44% of them had lesion recurrence; 20% a new lesion requiring dilatation; and 30% both recurrence and new lesion. Follow-up (mean 3.7 years) revealed 78% of patients having an improved anginal status, and 58% no angina. The cumulative probability of survival at 60 months was 88 +/- 3%. Angioplasty can be effectively employed in patients greater than or equal to 5 years remote from their last bypass surgery in native arteries or saphenous vein grafts with good procedural and long-term success. Vein graft age inherently does not appear to be a contraindication to angioplasty.
在304例患者中，有257例（85%）在最后一次搭桥手术后5年或更长时间成功接受了血管成形术（PTCA）。在尝试扩张的566条血管中，有496条（88%）病变成功扩张：386条冠状动脉中的332条（86%）以及180条静脉移植物中的164条（91%）。严重并发症包括：8例（2.6%）死亡、4例（1.3%）急诊手术、13例（4.3%）Q波心肌梗死以及14例（4.6%）远端栓塞。远端栓塞发生在180条扩张的静脉移植物病变中的13条（7%），通常导致非Q波梗死（13例远端栓塞中有4例）。89例（35%）患者接受了第二次PTCA：其中44%有病变复发；20%有新病变需要扩张；30%既有复发又有新病变。随访（平均3.7年）显示，78%的患者心绞痛状况改善，58%的患者无心绞痛。60个月时的累积生存概率为88±3%。血管成形术可有效地应用于最后一次搭桥手术5年或更长时间后的患者，无论是在原生动脉还是大隐静脉移植物中，手术成功率和长期成功率都很高。静脉移植物的年限本身似乎并不是血管成形术的禁忌证。
