Grondin C M, Vouhé P, Bourassa M G, Lespérance J, Bouvier M, Campeau L
J Thorac Cardiovasc Surg. 1978 Feb;75(2):161-7.
Twenty-two patients underwent coronary artery grafting with a circular vein graft comprising four or five distal coronary anastomoses. Postoperative angiographic evaluation showed patency in 90 (95.7 percent) of the 94 coronary anastomoses fashioned in this manner. All four occlusions occurred in the one patient whose graft comprised five anastomoses and was occluded beyond the first anastomosis on the right coronary artery (RCA). Eleven of the 94 anastomoses were made onto arteries with limited runoff. Blod flow averaged 214 ml. per minute (range 130 to 320) in the main portion of the graft and 59 ml. per minute (range 35 to 100) in the most distal segment. Flow doubled (averaged 403 ml. per minute) in the 11 grafts injected with papaverine. The technique of circular vein grafting is described in detail and potential pitfalls are outlined. The reasons for the high early patency rate are believed to be the following: (1) high flow in the proximal segment of the graft insuring patency of said segment, (2) termination on the left anterior descending (LAD) coronary artery providing good distal flow and patency. (3) diamond-shaped side-to-side anastomoses (SSA's) preventing angulation of the graft at these crucial points, and (4) nearly equidistant anchoring at the site of the multiple anastomoses giving the graft a smooth, even contour.
22例患者接受了使用包含四或五个远端冠状动脉吻合口的环形静脉移植物进行的冠状动脉搭桥术。术后血管造影评估显示，以这种方式构建的94个冠状动脉吻合口中，有90个（95.7%）通畅。所有4处闭塞均发生在1例患者身上，该患者的移植物包含5个吻合口，且在右冠状动脉（RCA）上第一个吻合口远端发生闭塞。94个吻合口中有11个是在血流灌注有限的动脉上进行的。移植物主要部分的血流平均为每分钟214毫升（范围为130至320毫升），最远端节段的血流平均为每分钟59毫升（范围为35至100毫升）。在11个注射罂粟碱的移植物中，血流增加了一倍（平均每分钟403毫升）。详细描述了环形静脉移植技术，并概述了潜在的陷阱。早期通畅率高的原因被认为如下：（1）移植物近端血流高，确保该节段通畅；（2）终止于左前降支（LAD）冠状动脉，提供良好的远端血流和通畅性；（3）菱形侧侧吻合（SSA）防止移植物在这些关键点处成角；（4）在多个吻合口部位几乎等距固定，使移植物具有光滑、均匀的轮廓。
