Walts A E, Fishbein M C, Sustaita H, Matloff J M
Circulation. 1982 Jan;65(1):197-201. doi: 10.1161/01.cir.65.1.197.
Although early occlusion of saphenous vein coronary artery bypass grafts is usually thrombotic, late occlusion is most often a result of progressive intimal fibromuscular proliferation or atheroma formation in the implanted vain. We describe another mechanism of late graft occlusion: atheromatous plaque rupture with superimposed occlusive thrombosis. Four men, ages 48-67 years underwent repeat bypass surgery for recurrent angina. Six of eight vein grafts excised 5-8 years after original bypass showed complete luminal occlusion by recent thrombus superimposed on ruptured atheromatous plaques. Similar findings were present at autopsy in two of three vein grafts from a 66-year-old man who died 7 years after bypass. These lesions are indistinguishable from those that occur in native coronary arteries of many patients with acute myocardial infarction. Unlike previously described graft occlusions, the present lesion represents a mechanism of acute, thrombotic, late graft occlusion. If recognized early, it may be amenable to nonsurgical intervention by angioplasty or thrombolysis.
虽然隐静脉冠状动脉旁路移植血管的早期闭塞通常是血栓形成性的，但晚期闭塞最常见的原因是植入静脉中内膜纤维肌肉进行性增生或动脉粥样硬化形成。我们描述了晚期移植血管闭塞的另一种机制：动脉粥样斑块破裂并伴有闭塞性血栓形成。4名年龄在48至67岁之间的男性因复发性心绞痛接受了再次搭桥手术。在初次搭桥手术5至8年后切除的8条静脉移植物中，有6条显示管腔被近期血栓完全阻塞，血栓覆盖在破裂的动脉粥样斑块上。在一名66岁男性患者的3条静脉移植物中，有2条在搭桥手术后7年死亡时进行尸检也发现了类似的结果。这些病变与许多急性心肌梗死患者的自身冠状动脉中出现的病变无法区分。与之前描述的移植血管闭塞不同，目前的病变代表了一种急性、血栓形成性、晚期移植血管闭塞的机制。如果早期识别，可能适合通过血管成形术或溶栓进行非手术干预。
