Ahn Sanghyun, Han Ahram, Kim Song-Yi, Choi Chanjoong, Min Sang-Il, Ha Jongwon, Hwang Ho Young, Kim Ki-Bong, Min Seung-Kee
Department of Surgery, Seoul National University Hospital, Seoul - Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul - Korea.
J Vasc Access. 2017 Jul 14;18(4):290-294. doi: 10.5301/jva.5000690. Epub 2017 Apr 14.
Ipsilateral arteriovenous fistula (AVF) may cause symptoms of coronary steal in patients who had undergone coronary artery bypass graft (CABG) using internal thoracic artery. The purpose of this study was to evaluate the adverse effects of ipsilateral AVF to CABG, including the incidence of coronary steal, and to analyze the risk factors for coronary steal.
Between 2000 and 2013, a total of 25 patients undergoing hemodialysis via upper extremity AVF, ipsilateral to the preexisting CABG, were reviewed retrospectively. Clinical assessment related to coronary steal, echocardiography before AVF, and coronary angiography after symptoms were assessed. The definition of coronary steal was the new development of one or more of the following symptoms within 12 weeks after AVF creation: chest pain, chest discomfort, and dyspnea.
Three patients were clinically diagnosed as coronary steal. Left ventricular ejection fraction (LVEF) was statistically lower in coronary steal group compared to no-steal group (41.7% vs. 50.9%; p = 0.036). Patients with coronary steal were older at the age of CABG surgery and showed a higher incidence of regional wall motion abnormality.
Coronary steal after ipsilateral AVF creation in patients with CABG using in situ internal thoracic artery (ITA) developed in 12%, which can be related to low LVEF. In patients with CABG requiring AVF for hemodialysis, the ipsilateral fistula to the grafted ITA should be carefully selected and performed.
同侧动静脉内瘘（AVF）可能会在使用胸廓内动脉进行冠状动脉旁路移植术（CABG）的患者中引发冠状动脉窃血症状。本研究的目的是评估同侧AVF对CABG的不良影响，包括冠状动脉窃血的发生率，并分析冠状动脉窃血的危险因素。
回顾性分析2000年至2013年间共25例通过上肢AVF进行血液透析的患者，这些AVF位于既往CABG的同侧。评估与冠状动脉窃血相关的临床情况、AVF术前的超声心动图以及出现症状后的冠状动脉造影。冠状动脉窃血的定义为在AVF建立后12周内出现以下一种或多种新症状：胸痛、胸部不适和呼吸困难。
3例患者临床诊断为冠状动脉窃血。冠状动脉窃血组的左心室射血分数（LVEF）在统计学上低于无窃血组（41.7%对50.9%；p = 0.036）。发生冠状动脉窃血的患者在进行CABG手术时年龄较大，且局部室壁运动异常的发生率较高。
在使用原位胸廓内动脉（ITA）进行CABG的患者中，同侧建立AVF后发生冠状动脉窃血的比例为12%，这可能与低LVEF有关。对于需要AVF进行血液透析的CABG患者，应谨慎选择并实施与移植的ITA同侧的内瘘。
