Antona C, Parolari A, Zanobini M, Arena V, Biglioli P
Department of Cardiac Surgery, University of Milan, Italy.
Ann Thorac Surg. 1996 Feb;61(2):702-5. doi: 10.1016/0003-4975(96)89375-1.
Recently the technical feasibility of reusing the left internal mammary artery (IMA) in coronary artery reoperation has been documented, but the patency of "recycled" IMAs has not yet been established.
In 4 patients undergoing coronary reoperation, five internal mammary arteries (3 left IMAs and 2 right IMAs) that were patent but severely stenotic at the anastomotic site were taken down and reused. In 2 cases the IMAs were reanastomosed to the same target coronary artery, in 2 cases the IMAs were rerouted to another coronary artery, and in 1 case an interposition of a short segment of the greater saphenous vein was needed to reach the target coronary artery.
Angiographic midterm evaluation, performed between 7 and 35 months postoperatively, showed patency of all the reused grafts without stenoses.
When feasible, recycling of the IMAs may be considered if one or both IMAs have been previously used and are stenotic in the perianastomotic area, or when there is a stenosis in the native coronary artery distal to the anastomosis itself.
最近已有文献证明在冠状动脉再次手术中复用左乳内动脉（IMA）的技术可行性，但“复用”IMA的通畅性尚未得到证实。
在4例接受冠状动脉再次手术的患者中，取下5条乳内动脉（3条左IMA和2条右IMA），这些动脉通畅但吻合部位严重狭窄，然后复用。2例中IMA重新吻合至同一目标冠状动脉，2例中IMA改道至另一冠状动脉，1例需要插入一小段大隐静脉以到达目标冠状动脉。
术后7至35个月进行的血管造影中期评估显示，所有复用移植物均通畅且无狭窄。
在可行的情况下，如果一条或两条IMA先前已被使用且吻合口周围区域狭窄，或者在吻合口本身远端的自身冠状动脉存在狭窄时，可考虑复用IMA。
