Avital S, Wacksman R, Rozenman Y, Mosseri M, Lotan C, Hasin Y, Gotsman M S
Cardiology Dept., Hadassah--Hebrew University Hospital, Ein Kerem, Jerusalem.
Harefuah. 1995 Aug;129(3-4):96-9, 159.
219 patients after previous coronary artery bypass grafting (CABG) underwent coronary artery or vein graft angioplasty in 1984-1991. 452 stenotic lesions out of 498 were successfully dilated in 337 procedures (90.7%). For arterial lesions the initial success rate had been 89.2% (321/360) and for vein graft lesions 94.9% (131/138). For repeated angioplasty the success rate was the same. Major complications included 3 deaths (0.9%). 15 myocardial infarctions (5.3%) and 1 emergency CABG. Factors that had reduced the success rate were lesions at the proximal anastomosis, total occlusions, and complex (type C) lesions. Time since grafting did not affect success rate of the second procedure. Restenosis after successful angioplasty was 37.3% (34/91) for arterial lesions and 56.8% (25/44) for graft lesions, after a mean time of 11.2 +/- 2.7 months. Restenosis was more common in type C lesions and old vein grafts. There was considerable improvement in treadmill exercise time of patients after the angioplasty (5.92 vs 7.31 minutes) and in double product. During a follow up of about 3 years, 7.6% (15/196) died of cardiac events, 5.2% (10/189) had myocardial infarctions, 10.5% (20/189) were reoperated and 31.0% (68/219) needed at least 1 repeat angioplasty. Long term followup was better after angioplasty of native arteries than of grafts. After angioplasty of vein grafts, there were more cardiac related deaths, more MIs and more reoperations than after angioplasty of native arteries: 11.5% vs 3.5%, 9.6% vs 2.8%, 21% vs 4.9%, respectively, than in the arterial group. Considering the high mortality and morbidity of reoperation, balloon angioplasty in selected patients may be the preferred strategy. Clinical and angiographic results are better after re-angioplasty of native arteries than vein grafts.
1984年至1991年间，219例曾接受冠状动脉旁路移植术（CABG）的患者接受了冠状动脉或静脉移植血管成形术。498处狭窄病变中的452处（90.7%）在337次手术中成功扩张。动脉病变的初始成功率为89.2%（321/360），静脉移植病变的成功率为94.9%（131/138）。重复血管成形术的成功率相同。主要并发症包括3例死亡（0.9%）、15例心肌梗死（5.3%）和1例急诊冠状动脉旁路移植术。降低成功率的因素包括近端吻合口病变、完全闭塞和复杂（C型）病变。移植术后时间不影响第二次手术的成功率。成功血管成形术后，动脉病变的再狭窄率为37.3%（34/91），移植血管病变的再狭窄率为56.8%（25/44），平均时间为11.2±2.7个月。再狭窄在C型病变和陈旧静脉移植血管中更为常见。血管成形术后患者的平板运动时间（5.92对7.31分钟）和双倍乘积有显著改善。在约3年的随访期间，7.6%（15/196）死于心脏事件，5.2%（10/189）发生心肌梗死，10.5%（20/189）接受再次手术，31.0%（68/219）至少需要1次重复血管成形术。自体动脉血管成形术后的长期随访结果优于移植血管。静脉移植血管成形术后，与心脏相关的死亡、心肌梗死和再次手术比自体动脉血管成形术后更多：分别为11.5%对3.5%、9.6%对2.8%、21%对4.9%，高于动脉组。考虑到再次手术的高死亡率和高发病率，对选定患者进行球囊血管成形术可能是首选策略。自体动脉再次血管成形术后的临床和血管造影结果优于静脉移植血管。
