Atkinson J B, Forman M B, Perry J M, Virmani R
Am J Cardiol. 1985 Apr 1;55(8):952-5. doi: 10.1016/0002-9149(85)90725-8.
Previous studies of saphenous vein (SV) bypass grafts have been either angiographic or morphologic, and few have correlated angiograms with histology. Nine necropsy patients who had received 21 SV implants 12 to 120 months (mean 67 +/- 42) before death were studied. All patients had severe coronary artery disease. Three types of histologic changes were found: atherosclerosis in 9 grafts, fibrointimal proliferation in 8 and total occlusion with fibrosis in 4. All patients had premortem angiograms 0 to 3 months (mean 0.7 +/- 1.1) before death. In 14 of 21 grafts, premortem angiograms accurately reflected the postmortem findings. In 7 grafts, the premortem angiograms either overestimated (4 grafts) or underestimated (3 grafts) the extent of luminal narrowing. Six of the 7 SV implants incorrectly assessed by angiography had fibrointimal proliferation and 1 had atherosclerosis. The presence of smooth muscle in SV implants with fibrointimal proliferation may be a mechanism of spasm or relaxation during angiography, which could cause errors in estimating the degree of stenosis. Nitrates or calcium antagonists may be useful in both assessing the degree of underlying vasomotion in SV grafts and as a therapeutic modality.
以往对大隐静脉（SV）旁路移植血管的研究，不是血管造影方面的，就是形态学方面的，很少有将血管造影与组织学相关联的。对9例尸检患者进行了研究，这些患者在死亡前12至120个月（平均67±42个月）接受了21次大隐静脉植入。所有患者均患有严重冠状动脉疾病。发现了三种组织学变化：9条移植血管中有动脉粥样硬化，8条有纤维内膜增生，4条完全闭塞并伴有纤维化。所有患者在死亡前0至3个月（平均0.7±1.1个月）都进行了生前血管造影。在21条移植血管中的14条，生前血管造影准确反映了死后的检查结果。在7条移植血管中，生前血管造影要么高估了（4条），要么低估了（3条）管腔狭窄程度。血管造影评估错误的7条大隐静脉植入血管中，6条有纤维内膜增生，1条有动脉粥样硬化。有纤维内膜增生的大隐静脉植入血管中平滑肌的存在，可能是血管造影期间痉挛或舒张的一种机制，这可能导致在估计狭窄程度时出现误差。硝酸盐或钙拮抗剂在评估大隐静脉移植血管潜在血管运动程度以及作为一种治疗方式方面可能都有用。
