Antona C, B1tto A A, Zanobini M, Pompilio G, Spirito R, Apostolo A, Arena V, Biglioli P
Cattedra di Cardiochirurgia I, Università degli Studi di Milano.
Minerva Cardioangiol. 1994 Nov;42(11):527-33.
It has been well established that the internal thoracic artery (ITA) is a good alternative to the saphenous vein as conduit for coronary artery bypass grafting because of superior early and late patency. Many surgeons now commonly use both ITAs for CABG and many have adopted complex grafting methods such as free ITA graft and sequential anastomosis; despite these techniques, it's not always possible to achieve complete revascularization with arterial conduits. More recently the right gastroepiploic artery (rGEA) and the inferior epigastric artery (IEA) have been used as alternative arterial conduits. The authors report the experience of a case of myocardial revascularization in a patient with angina not responsive to medical therapy, severe tri-vessel coronary artery disease, which had a previous total bilateral saphenectomy; the patient was also found to have a right fibrothorax. In the surgical strategy the authors considered that the bilateral use of mammary artery could have been the cause of the depressed respiratory function and that it was important to leave intact the left hemithorax; they therefore employed the rITA in the revascularization of the anterior descending (AD). To complete the revascularization they used the IEA for a marginal branch of the circumflex artery and the rGEA for the interventricular posterior artery, branch of the right coronary artery. In this fashion good early results were obtained with absence of perioperative complications with a good life expectancy.
胸内动脉（ITA）作为冠状动脉旁路移植术的血管桥优于大隐静脉，因为其早期和晚期通畅率更高，这一点已经得到充分证实。现在许多外科医生在冠状动脉旁路移植术中通常会使用双侧ITA，并且许多人采用了复杂的移植方法，如游离ITA移植和序贯吻合术；尽管有这些技术，但使用动脉血管桥并不总是能够实现完全血运重建。最近，右胃网膜动脉（rGEA）和腹壁下动脉（IEA）已被用作替代动脉血管桥。作者报告了1例对药物治疗无反应的心绞痛、严重三支冠状动脉疾病且之前已行双侧大隐静脉切除术患者的心肌血运重建经验；该患者还患有右侧纤维胸。在手术策略上，作者认为双侧使用乳内动脉可能是呼吸功能下降的原因，保留左半胸很重要；因此，他们在左前降支（AD）血运重建中使用了右侧胸内动脉。为完成血运重建，他们使用IEA为旋支动脉的一个边缘分支搭桥，使用rGEA为右冠状动脉分支的后降支动脉搭桥。通过这种方式，获得了良好的早期效果，围手术期无并发症，预期寿命良好。
