Cowley M J, DiSciascio G
Division of Cardiology, Medical College of Virginia, Richmond.
Cathet Cardiovasc Diagn. 1993;Suppl 1:10-6.
Saphenous vein grafts (SVG) comprise a significant and increasing proportion of coronary interventional procedures at most centers. Directional coronary atherectomy (DCA) is well suited for treating focal SVG disease and is an effective therapy for lesions located in the ostium, shaft or body, and distal insertion site of saphenous vein grafts. Aorto-ostial SVG lesions may be technically difficult due to angulation and inability to fully engage the guide catheter, but success rates are relatively high and excellent angiographic results are usually achieved. Use of alternative guide catheters and stiffer guide wires can facilitate successful DCA of aorto-ostial lesions. DCA of SVG shaft segments or distal insertion sites are also associated with high success and low complication rates. Complex and thrombus-containing vein graft lesions are often well suited for DCA, and both patent and occluded grafts with extensive thrombus may also be effectively treated with DCA following selective intragraft thrombolysis. Technical aspects of vein graft DCA for these applications are reviewed.
在大多数中心，大隐静脉移植血管（SVG）在冠状动脉介入手术中所占比例显著且不断增加。定向冠状动脉斑块旋切术（DCA）非常适合治疗局限性SVG病变，对于位于大隐静脉移植血管开口、主干或体部以及远端吻合口部位的病变是一种有效的治疗方法。由于成角以及无法完全插入引导导管，主动脉-开口处SVG病变在技术上可能具有挑战性，但成功率相对较高，通常能取得优异的血管造影结果。使用替代引导导管和更硬的导丝有助于成功进行主动脉-开口处病变的DCA。SVG主干段或远端吻合口部位的DCA成功率也很高，并发症发生率低。复杂且含血栓的静脉移植血管病变通常非常适合DCA，在选择性移植血管内溶栓后，有广泛血栓的通畅和闭塞移植血管也可用DCA有效治疗。本文综述了这些应用中静脉移植血管DCA的技术要点。
