Puig L B, Sousa A H, Cividanes G V, Souto R C, Bittencourt A H, Oppi E C, Kopel L, Ramirez J A
Real e Benemérita Sociedade Portuguesa de Beneficĕncia, São Paulo, Brazil.
Eur J Cardiothorac Surg. 1997 Feb;11(2):243-7. doi: 10.1016/s1010-7940(96)01054-8.
We present the initial experience with the use of inferior epigastric artery as a free graft for myocardial revascularization in a series of 41 patients operated on between 1987 and 1989 to show the clinical and angiographic results. Of the 41 patients, 29 were male, 12 female, with ages ranging from 33 to 72 years, and weights from 50 to 86 kg. The inferior epigastric artery grafts were predominantly employed to the anterior interventricular branch and diagonal branch. The proximal anastomosis into the aorta was done directly or with a patch of vein or pericardium. The 32 patients who survived had mean follow-up of 82 months and 22 are in functional class I, 8 in class II and 2 in class III of angina. The early patency rate was: inferior epigastric artery-anterior interventricular branch, 85.7% and inferior epigastric artery-diagonal branch. 85.7%. Sixteen patients underwent angiographic study at a mean follow-up of 81.2 months and the patency rate to the anterior interventricular branch was 77.7% and to the diagonal branch was 100%. Three patients with early occluded inferior epigastric artery were reoperated on 3, 3 and 11 months after the operation. A filiform lumen of the graft and a small ostium in the aorta was found and explained the imperfection of the direct anastomosis due to unbalance thickness of the graft and the aortic wall. Therefore it is occluded that the inferior epigastric artery is an alternative arterial graft for myocardial revascularization and that the use of a vein or pericardium patch can help the proximal anastomosis and improve potency of the graft.
我们介绍了1987年至1989年间对41例患者使用腹壁下动脉作为游离移植物进行心肌血运重建的初步经验，以展示临床和血管造影结果。41例患者中，男性29例，女性12例，年龄33至72岁，体重50至86千克。腹壁下动脉移植物主要用于前室间支和对角支。近端与主动脉的吻合直接进行，或使用一段静脉或心包片。32例存活患者的平均随访时间为82个月，其中22例心功能为I级，8例为II级，2例为III级心绞痛。早期通畅率为：腹壁下动脉-前室间支85.7%，腹壁下动脉-对角支85.7%。16例患者在平均随访81.2个月时接受了血管造影检查，前室间支的通畅率为77.7%，对角支为100%。3例腹壁下动脉早期闭塞的患者在术后3、3和11个月进行了再次手术。发现移植物呈丝状管腔且主动脉开口较小，这解释了由于移植物和主动脉壁厚度不平衡导致直接吻合不完善的原因。因此，可以得出结论，腹壁下动脉是心肌血运重建的一种替代动脉移植物，使用静脉或心包片有助于近端吻合并提高移植物的效能。
