Dianati Maleki Neda, Ehteshami Afshar Arash, Parikh Puja B
Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
Curr Treat Options Cardiovasc Med. 2019 Feb 28;21(2):12. doi: 10.1007/s11936-019-0714-7.
In this review, we summarize the pathogenesis of saphenous venous graft (SVG) failure in patients following coronary artery bypass graft (CABG) surgery. We also provide an update on various aspects of prevention and management of SVG failure.
Application of perioperative measures and medical therapies to promote SVG patency is crucial to optimize clinical outcomes in patients following CABG. Percutaneous coronary intervention (PCI) of SVG disease is fraught with complications, with the highest risk being no-reflow and periprocedural myocardial infarction due to distal embolization of microemboli. Minimizing this risk with use of distal embolic protection when feasible and understanding the role of adjunctive pharmacotherapies is critical in reducing the risk of adverse cardiac events. The long-term patency of SVGs remains a contemporary challenge and is adversely affected by thrombotic occlusion, intimal fibrosis, and accelerated atherosclerosis. Prevention of SVG failure is multifactorial. Use of perioperative measures, medical therapies, and PCI techniques to promote SVG patency is vital to optimize outcomes in patients following CABG. Further prospective trials are needed to define the optimal medical and surgical therapy to maintain short- and long term SVG patency.
在本综述中，我们总结了冠状动脉旁路移植术（CABG）后患者大隐静脉移植物（SVG）失败的发病机制。我们还提供了关于SVG失败预防和管理各方面的最新情况。
应用围手术期措施和药物治疗以促进SVG通畅对于优化CABG术后患者的临床结局至关重要。SVG疾病的经皮冠状动脉介入治疗（PCI）充满并发症，其中最高风险是无复流以及由于微栓子远端栓塞导致的围手术期心肌梗死。在可行时使用远端栓塞保护措施将这种风险降至最低，并了解辅助药物治疗的作用对于降低不良心脏事件风险至关重要。SVG的长期通畅仍然是一个当代挑战，并且受到血栓闭塞、内膜纤维化和加速动脉粥样硬化的不利影响。SVG失败的预防是多因素的。应用围手术期措施、药物治疗和PCI技术以促进SVG通畅对于优化CABG术后患者的结局至关重要。需要进一步的前瞻性试验来确定维持SVG短期和长期通畅的最佳药物和手术治疗方法。
