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全动脉血运重建：评估复合移植物构型中桡动脉的长度。

Total Arterial Revascularization: Evaluating the Length of the Radial Artery in a Composite Graft Configuration.

机构信息

Faculty of Medicine, Institute of Surgical Pathology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.

University Ottawa Heart Center, Ottawa, Canada.

出版信息

Ann Thorac Cardiovasc Surg. 2024 Jan 26;30(1). doi: 10.5761/atcs.oa.23-00084. Epub 2023 Oct 28.

DOI:10.5761/atcs.oa.23-00084
PMID:37899176
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10902649/
Abstract

PURPOSE

Reimplanting the radial artery in the left internal thoracic artery as a composite graft allows total arterial revascularization (TAR) without aortic manipulation. The limitation of this strategy is the length of the radial artery required to reach distal right coronary artery (RCA) branches. Our analysis focuses on the feasibility of this strategy.

METHODS

A total of 169 patients underwent TAR using the radial artery in a composite grafting configuration. Length of the radial artery, number of sequential anastomoses, heart size, target location, length of the arm, patient height, body surface area, and flow in the composite graft were prospectively collected.

RESULTS

The mean length of the radial artery was 18.02 cm. Patients with a mean length of the radial artery of 15.9 cm needed an extension of the radial artery with another conduit to reach the RCA distal branches. When T-configuration is used, the length of the radial artery should be 0.53 cm per sequential anastomosis to reach the RCA distal branches.

CONCLUSIONS

Our study shows that an average length of 18.02 cm of radial artery is needed to reach targets on the RCA distal branches in composite grafting. In T-configuration, we need 0.53 cm more length per anastomosis to achieve TAR.

摘要

目的

将桡动脉重新植入左内乳动脉作为复合移植物，可以在不进行主动脉操作的情况下实现完全动脉血运重建（TAR）。这种策略的局限性在于到达右冠状动脉（RCA）远端分支所需的桡动脉长度。我们的分析重点是该策略的可行性。

方法

共有 169 例患者采用桡动脉复合移植方式进行 TAR。前瞻性收集桡动脉长度、连续吻合口数量、心脏大小、靶部位、手臂长度、患者身高、体表面积和复合移植物的血流量。

结果

桡动脉的平均长度为 18.02cm。平均桡动脉长度为 15.9cm 的患者需要使用另一个导管延长桡动脉以到达 RCA 远端分支。当使用 T 型构型时，每进行一次连续吻合，桡动脉的长度应为 0.53cm，才能到达 RCA 远端分支。

结论

我们的研究表明，在复合移植中，到达 RCA 远端分支的桡动脉平均长度需要 18.02cm。在 T 型构型中，每进行一次吻合，我们需要增加 0.53cm 的长度才能实现 TAR。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/b1866d23c6cb/atcs-30-1-23-00084-figure04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/3e3c347b981e/atcs-30-1-23-00084-figure01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/da5c782c761b/atcs-30-1-23-00084-figure02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/9c65bd5718af/atcs-30-1-23-00084-figure03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/b1866d23c6cb/atcs-30-1-23-00084-figure04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/3e3c347b981e/atcs-30-1-23-00084-figure01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/da5c782c761b/atcs-30-1-23-00084-figure02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/9c65bd5718af/atcs-30-1-23-00084-figure03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7bc/10902649/b1866d23c6cb/atcs-30-1-23-00084-figure04.jpg

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本文引用的文献

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Interact Cardiovasc Thorac Surg. 2022 Mar 31;34(4):515-522. doi: 10.1093/icvts/ivab279.
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The radial artery in coronary surgery, 2018.2018年冠状动脉手术中的桡动脉
Indian J Thorac Cardiovasc Surg. 2018 Dec;34(Suppl 3):234-244. doi: 10.1007/s12055-018-0694-3. Epub 2018 Sep 24.
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Long-Term Results of the RAPCO Trials.RAPCO 试验的长期结果。
Circulation. 2020 Oct 6;142(14):1330-1338. doi: 10.1161/CIRCULATIONAHA.119.045427. Epub 2020 Oct 5.
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Current Status of Off-Pump Coronary Artery Bypass.非体外循环冠状动脉搭桥术的现状
Ann Thorac Cardiovasc Surg. 2020 Jun 20;26(3):125-132. doi: 10.5761/atcs.ra.18-00286. Epub 2020 May 29.
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Bilateral internal thoracic artery versus radial artery multi-arterial bypass grafting: a report from the STS database†.双侧内乳动脉与桡动脉多动脉旁路移植术：来自 STS 数据库的报告†。
Eur J Cardiothorac Surg. 2019 Nov 1;56(5):926-934. doi: 10.1093/ejcts/ezz106.
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'Ten commandments' for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization.2018年欧洲心脏病学会/欧洲心胸外科学会心肌血运重建指南的“十诫”
Eur Heart J. 2019 Jan 7;40(2):79-80. doi: 10.1093/eurheartj/ehy855.
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Technical Aspects of the Use of the Radial Artery in Coronary Artery Bypass Surgery.桡动脉在冠状动脉旁路移植术中的应用技术要点。
Ann Thorac Surg. 2019 Aug;108(2):613-622. doi: 10.1016/j.athoracsur.2018.10.066. Epub 2018 Dec 12.
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Multiple Arterial Grafting Is Associated With Better Outcomes for Coronary Artery Bypass Grafting Patients.多支动脉搭桥术与冠状动脉旁路移植术患者的更好结局相关。
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Sequential Grafting of in Situ Skeletonized Left Internal Mammary Artery to the Left Coronary System.原位骨骼化左乳内动脉序贯移植至左冠状动脉系统。
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Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery.冠状动脉旁路移植术中的桡动脉或隐静脉移植物。
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