外侧肋间动脉作为冠状动脉旁路移植术后“窃血”现象的病因：一例病例报告及文献复习
Lateral costal artery as a culprit for the steal phenomenon after coronary artery bypass grafting: a case report and review of the literature.
作者信息
Trebišovský Michal, Homola Marián, Kolesár Adrián, Lukačin Štefan, Bereš Anton
机构信息
Department of Heart Surgery, East Slovak Institute for Cardiovascular Diseases, Ondavská 8, Košice, 040 12, Slovakia.
Medical Faculty, Pavol Jozef Šafárik University, Trieda SNP 1, Košice, 040 11, Slovakia.
出版信息
J Cardiothorac Surg. 2025 Jan 7;20(1):38. doi: 10.1186/s13019-024-03273-x.
BACKGROUND
The left internal thoracic artery (LITA) has been widely accepted as the standard for revascularizing the left anterior descending artery during coronary artery bypass grafting (CABG) surgery. However, in 10-20% of cases, the LITA may lead to unsecured side branches to the chest wall, particularly the lateral costal artery (LCA), potentially resulting in postoperative chest angina.
CASE PRESENTATION
We report the case of a 58-year-old patient who experienced persistent angina eight months after having undergone coronary artery bypass grafting (CABG) due to the steal phenomenon caused by a thick lateral costal artery (LCA). The LCA was found to be 2/3 the diameter of the left internal thoracic artery (LITA) with the decision to obliterate the LCA. Following LCA obliteration, the patient's exertional angina was resolved.
CONCLUSIONS
LCA may pose a potential issue in terms of coronary steal after CABG. Understanding the anatomy of the LITA with LCA variation and widening the opening of the pleura may be beneficial in preventing postoperative steal in selected cases.
背景
在冠状动脉旁路移植术（CABG）中，左乳内动脉（LITA）已被广泛接受为左前降支血管重建的标准。然而，在10%至20%的病例中，LITA可能会导致胸壁侧支血管不牢固，尤其是肋间外侧动脉（LCA），这可能会导致术后胸痛。
病例报告
我们报告了一例58岁患者的病例，该患者在接受冠状动脉旁路移植术（CABG）八个月后，因粗大的肋间外侧动脉（LCA）导致的窃血现象而持续胸痛。发现LCA的直径为左乳内动脉（LITA）的2/3，并决定闭塞LCA。闭塞LCA后，患者的劳力性心绞痛得到缓解。
结论
LCA在CABG术后的冠状动脉窃血方面可能是一个潜在问题。了解LITA与LCA变异的解剖结构并扩大胸膜开口，在某些特定病例中可能有助于预防术后窃血。
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