Dietl C A, Benoit C H
Department of Cardiovascular Surgery, Geisinger Medical Center, Danville, PA 17822-1343, USA.
Ann Thorac Surg. 1995 Jul;60(1):102-9; discussion 109-10.
Use of the radial artery for coronary artery bypass grafting is controversial.
Between November 1992 and December 1994, the radial artery artery graft was used in 165 patients (mean age, 63.7 years) undergoing coronary revascularization. To prevent spasm, the radial artery was not skeletonized, and calcium-channel blockers were administered routinely.
No ischemic or functional complications occurred in the hand after harvesting of the radial artery. Only 1 patient (0.6%) sustained a perioperative myocardial infarction in an area revascularized with a radial artery. The overall mortality was 3.0% (5 patients), but no deaths were caused by failure of the radial artery graft. During a mean follow-up of 14.0 months, angina recurred in 5 patients (3.0%), all of whom had widely patent radial artery grafts on angiography. Radionuclide exercise studies were performed 1 year after operation in 84 patients, 2 of whom (2.4%) had stress-induced defects in areas grafted with a radial artery.
Perioperative myocardial infarction, mortality, and recurrent angina usually were not related to failure of the radial artery graft. Our results suggest that the radial artery is an excellent alternative conduit for myocardial revascularization and may be used safely, especially in patients with poor-quality or unavailable saphenous veins.
在冠状动脉旁路移植术中使用桡动脉存在争议。
1992年11月至1994年12月期间，165例（平均年龄63.7岁）接受冠状动脉血运重建的患者使用了桡动脉移植。为防止痉挛，未对桡动脉进行骨骼化处理，并常规给予钙通道阻滞剂。
摘取桡动脉后手部未出现缺血或功能并发症。仅1例患者（0.6%）在接受桡动脉血运重建的区域发生围手术期心肌梗死。总体死亡率为3.0%（5例患者），但无死亡是由桡动脉移植失败导致的。在平均14.0个月的随访期间，5例患者（3.0%）心绞痛复发，所有这些患者在血管造影检查中桡动脉移植血管均通畅。84例患者在术后1年进行了放射性核素运动试验，其中2例（2.4%）在接受桡动脉移植的区域出现应激诱导缺损。
围手术期心肌梗死、死亡率和复发性心绞痛通常与桡动脉移植失败无关。我们的结果表明，桡动脉是心肌血运重建的一种极佳替代管道，尤其在大隐静脉质量差或无法获取的患者中可安全使用。
