Daly R C, McCarthy P M, Orszulak T A, Schaff H V, Edwards W D
Section of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. 55905.
J Thorac Cardiovasc Surg. 1988 Jul;96(1):19-29.
This study compares patency and histologic structure of in situ internal mammary artery grafts, free internal mammary artery grafts, stripped, free internal mammary artery grafts, and stripped, free superficial femoral artery grafts (a muscular artery model) in a canine model of coronary artery bypass. Twenty-four adult mongrel dogs underwent bypass of the circumflex coronary artery with one of the above grafts. Three months postoperatively, graft patency was assessed by angiogram, and postmortem specimens were studied by intraluminal injection of a dilute barium solution proximal to the graft. Proximal, mid, and distal segments of each graft were examined microscopically. In situ internal mammary artery grafts and free internal mammary artery grafts were not significantly different in regard to patency, vascular wall cellular structure, or perfusion of the vasa vasorum. The stripped, free internal mammary artery group had a higher incidence of thrombosis, intimal thickening, and medial injury than the pedicled (in situ and free internal mammary artery) grafts. This difference may be due to early vascular wall ischemia as a result of poor early perfusion of the vasa vasorum. The stripped, free superficial femoral artery grafts were all patent, but all had adventitial injury.
本研究在犬冠状动脉搭桥模型中，比较了原位乳内动脉移植物、游离乳内动脉移植物、去外膜游离乳内动脉移植物以及去外膜游离股浅动脉移植物（一种肌性动脉模型）的通畅情况和组织学结构。24只成年杂种犬用上述移植物之一进行了左旋冠状动脉搭桥。术后3个月，通过血管造影评估移植物通畅情况，并通过在移植物近端腔内注射稀释的钡溶液对死后标本进行研究。对每个移植物的近端、中段和远端节段进行显微镜检查。原位乳内动脉移植物和游离乳内动脉移植物在通畅情况、血管壁细胞结构或血管滋养管灌注方面无显著差异。与带蒂（原位和游离乳内动脉）移植物相比，去外膜游离乳内动脉组血栓形成、内膜增厚和中膜损伤的发生率更高。这种差异可能是由于血管滋养管早期灌注不良导致早期血管壁缺血所致。去外膜游离股浅动脉移植物均通畅，但均有外膜损伤。
