Walts A E, Fishbein M C, Matloff J M
Division of Anatomic Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Am Heart J. 1987 Oct;114(4 Pt 1):718-23. doi: 10.1016/0002-8703(87)90780-0.
During the past decade the number of patients undergoing saphenous vein coronary artery bypass grafting (CABG) has increased worldwide. With a rate of late graft occlusion approximating 4% each year, the number of patients at risk for late graft occlusion continues to increase. Whereas in 1976 only 0.8% of the CABGs performed at our institution were reoperations for occluded grafts, by 1985 repeat procedures comprised 12.4% of the CABGs performed. Excised, occluded saphenous vein grafts from 52 of 119 (44%) of these patients showed thrombosis superimposed on ruptured atheromatous plaques. Ten autopsy patients showed similar lesions in their occluded grafts. The lesion was present in grafts excised as early as 3 years and as late as 14 years after bypass surgery; most occurred 5 to 10 years after implantation. Neither age at first bypass, sex, nor coronary artery bypassed permitted prediction of the occurrence of the lesion. Thrombosed, ruptured atheromatous plaque is a common, clinically significant mechanism of late graft occlusion. It is associated with recurrent symptoms that necessitate repeat revascularization and may result in death. The lesion may also be amenable to thrombolytic therapy, angioplasty, or both.
在过去十年中，全球接受大隐静脉冠状动脉旁路移植术（CABG）的患者数量有所增加。由于移植血管晚期闭塞率每年约为4%，面临移植血管晚期闭塞风险的患者数量持续上升。1976年在我们机构进行的CABG手术中，因移植血管闭塞而进行再次手术的仅占0.8%，到1985年，再次手术的比例占所进行CABG手术的12.4%。在这些患者中，119例中有52例（44%）切除的闭塞大隐静脉移植血管显示血栓形成叠加在破裂的动脉粥样硬化斑块上。10例尸检患者的闭塞移植血管也有类似病变。该病变在旁路手术后3年至14年切除的移植血管中均有出现；大多数发生在植入后5至10年。首次旁路手术时的年龄、性别或所绕过的冠状动脉均无法预测该病变的发生。血栓形成、破裂的动脉粥样硬化斑块是移植血管晚期闭塞常见的、具有临床意义的机制。它与需要再次血运重建的复发症状相关，可能导致死亡。该病变也可能适用于溶栓治疗、血管成形术或两者结合。
