Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
Nat Rev Cardiol. 2016 Aug;13(8):451-70. doi: 10.1038/nrcardio.2016.76. Epub 2016 May 19.
Occlusive arterial disease is a leading cause of morbidity and mortality worldwide. Aside from balloon angioplasty, bypass graft surgery is the most commonly performed revascularization technique for occlusive arterial disease. Coronary artery bypass graft surgery is performed in patients with left main coronary artery disease and three-vessel coronary disease, whereas peripheral artery bypass graft surgery is used to treat patients with late-stage peripheral artery occlusive disease. The great saphenous veins are commonly used conduits for surgical revascularization; however, they are associated with a high failure rate. Therefore, preservation of vein graft patency is essential for long-term surgical success. With the exception of 'no-touch' techniques and lipid-lowering and antiplatelet (aspirin) therapy, no intervention has hitherto unequivocally proven to be clinically effective in preventing vein graft failure. In this Review, we describe both preclinical and clinical studies evaluating the pathophysiology underlying vein graft failure, and the latest therapeutic options to improve patency for both coronary and peripheral grafts.
闭塞性动脉疾病是全球发病率和死亡率的主要原因。除了球囊血管成形术外，旁路移植手术是治疗闭塞性动脉疾病最常用的血运重建技术。冠状动脉旁路移植术用于治疗左主干冠状动脉疾病和三支血管病变的患者，而外周动脉旁路移植术则用于治疗晚期外周动脉闭塞性疾病的患者。大隐静脉是外科血运重建常用的移植物；然而，它们与高失败率相关。因此，保持静脉移植物通畅对于长期手术成功至关重要。除了“无接触”技术以及降脂和抗血小板（阿司匹林）治疗外，迄今为止，没有任何干预措施被明确证明在预防静脉移植物失败方面具有临床疗效。在这篇综述中，我们描述了评估静脉移植物失败基础生理学的临床前和临床研究，以及改善冠状动脉和外周移植物通畅性的最新治疗选择。
