Waller B F, Rothbaum D A, Gorfinkel H J, Ulbright T M, Linnemeier T J, Berger S M
J Am Coll Cardiol. 1984 Oct;4(4):784-92. doi: 10.1016/s0735-1097(84)80407-6.
Clinical and morphologic observations from two patients undergoing percutaneous transluminal angioplasty of stenotic aortocoronary saphenous vein bypass grafts early (3 months) and late (56 months) after graft insertion are described. Each patient had one or more clinically successful graft dilations resulting in an angiographic increase in luminal diameter and a decrease in mean trans-stenotic gradient, and each had restenosis of the graft at the site of previous angioplasty within 2 months of dilation. Both operatively excised grafts had diffuse but variable amounts of intimal fibrous thickening and severe narrowing at the previous angioplasty site. The early graft had no evidence of dilation injury, and the intimal thickening consisted solely of fibrocollagenous tissue free of calcific deposits. In contrast, the late graft had a healing intimal dissection at the angioplasty site, and the intimal thickening consisted of atherosclerotic plaque with calcific deposits. Angiographic and morphologic correlations suggest that the mechanism of saphenous vein angioplasty early (less than or equal to 1 year) after insertion is by graft "stretching," while late (greater than 1 year) after insertion it is by atherosclerotic plaque "fracture" similar to that observed in atherosclerotic coronary arteries subjected to angioplasty procedures.
描述了两例患者在大隐静脉旁路移植术后早期（3个月）和晚期（56个月）接受经皮腔内血管成形术治疗狭窄性主动脉冠状动脉大隐静脉旁路移植血管的临床和形态学观察结果。每位患者均有一次或多次临床成功的移植血管扩张，导致血管造影显示管腔直径增加，平均跨狭窄梯度降低，且每位患者在扩张后2个月内，移植血管在先前血管成形术部位出现再狭窄。手术切除的两根移植血管均有弥漫但程度不一的内膜纤维增厚，且在先前血管成形术部位有严重狭窄。早期移植血管无扩张损伤迹象，内膜增厚仅由无钙化沉积的纤维胶原组织构成。相比之下，晚期移植血管在血管成形术部位有愈合中的内膜夹层，内膜增厚由伴有钙化沉积的动脉粥样硬化斑块构成。血管造影和形态学相关性提示，大隐静脉血管成形术在移植术后早期（小于或等于1年）的机制是移植血管“拉伸”，而在移植术后晚期（大于1年）则是类似于接受血管成形术的动脉粥样硬化冠状动脉中观察到的动脉粥样硬化斑块“破裂”。
