Nakao T, Kawaue Y
Department of Cardiovascular Surgery, Koseiren Hiroshima General Hospital, Hiroshima, Japan.
J Thorac Cardiovasc Surg. 1993 Jul;106(1):149-53.
In recent years, the right gastroepiploic artery has been attracting attention as a second reliable arterial graft for clinical application. In this study we measured the postoperative graft diameter of the right gastroepiploic artery and demonstrated the postoperative "thinning down" phenomenon of the right gastroepiploic artery graft. We report on coronary revascularization with the right gastroepiploic artery in 55 cases from December 1989 to July 1991. The properties of right gastroepiploic artery grafts were comparatively examined with the use of postoperative angiographic findings when possible. The results revealed that the patency ratio of right gastroepiploic artery grafts was satisfactory, with an average diameter of 2.1 mm (range 1.2 to 3.5 mm). "String sign" was not observed in these cases, but thinning down was noted in four cases. The thinning down phenomenon of the right gastroepiploic artery had previously been defined as a graft diameter no greater than that of a 5F catheter, with ineffective graft flow; it was termed slender sign. The development of slender sign is caused by good native coronary flow, narrowing of the perfused region, and poor runoff. Three cases of slender sign caused by good native flow had no signs of ischemia in the perfused regions, which was indicative of sufficient blood supply to the myocardium. The long-term patency ratio of right gastroepiploic artery grafts should be evaluated further.
近年来，胃网膜右动脉作为第二种可靠的临床应用动脉移植物受到关注。在本研究中，我们测量了胃网膜右动脉移植术后的移植物直径，并证实了胃网膜右动脉移植物术后的“变细”现象。我们报告了1989年12月至1991年7月期间55例使用胃网膜右动脉进行冠状动脉血运重建的病例。尽可能利用术后血管造影结果对胃网膜右动脉移植物的特性进行了比较研究。结果显示，胃网膜右动脉移植物的通畅率令人满意，平均直径为2.1毫米（范围为1.2至3.5毫米）。这些病例中未观察到“串珠征”，但有4例出现了变细现象。胃网膜右动脉的变细现象以前被定义为移植物直径不大于5F导管，移植物血流无效；称之为纤细征。纤细征的发生是由于冠状动脉自身血流良好、灌注区域狭窄和血流流出不畅所致。3例由冠状动脉自身血流良好引起的纤细征在灌注区域没有缺血迹象，这表明心肌有足够的血液供应。胃网膜右动脉移植物的长期通畅率应进一步评估。
