Hake U, Düber C, Hilker M, Schmid F X, Oelert H
Department of Cardiac, Thoracic and Vascular Surgery, Johannes Gutenberg University, Mainz, Germany.
Thorac Cardiovasc Surg. 1996 Jun;44(3):147-9. doi: 10.1055/s-2007-1012004.
During a two-years period we have treated 6 patients where use of the internal thoracic artery for coronary artery grafting was precluded because of extrathoracic arteriosclerotic vascular lesions. In four patients with severe aorto-iliac occlusive disease preoperative digital angiography demonstrated collateralisation of the lower extremity by either the left, right, or both internal thoracic arteries (ITA). In these cases use of the ITA was excluded in order to preserve the collateral supply and coronary bypass grafting was performed using only saphenous vein. In two patients with proximal occlusion of the left subclavian artery the right ITA was used as in-situ bypass to graft the left anterior descending artery. All patients survived the operation without development of a perioperative myocardial infarction, neurological deficit, or peripheral ischemia. Although they rarely do, extrathoracic vascular disorders can exclude the use of the ITA for grafting. Especially in the case of aorto-iliac occlusive disease or proximal arteriosclerotic subclavian lesions angiographic evaluation is mandatory to prevent the development of life-threatening peripheral ischemia by harvesting an ITA and to avoid the use of an inadequate ITA graft with in-flow occlusion.
在两年时间里，我们治疗了6例患者，这些患者因胸外动脉硬化性血管病变而无法使用胸廓内动脉进行冠状动脉搭桥术。在4例患有严重主-髂动脉闭塞性疾病的患者中，术前数字血管造影显示左、右或双侧胸廓内动脉（ITA）使下肢形成侧支循环。在这些病例中，为了保留侧支供血而排除了使用ITA，仅使用大隐静脉进行冠状动脉搭桥术。在2例左锁骨下动脉近端闭塞的患者中，右侧ITA被用作原位旁路移植左前降支动脉。所有患者均存活，未发生围手术期心肌梗死、神经功能缺损或外周缺血。胸外血管疾病虽然很少见，但可能会排除使用ITA进行移植。特别是在主-髂动脉闭塞性疾病或近端动脉硬化性锁骨下病变的情况下，必须进行血管造影评估，以防止因采集ITA而导致危及生命的外周缺血，并避免使用流入道闭塞的不充分的ITA移植物。
