Goh K, Sasajima T, Inaba M, Yamamoto H, Azuma N, Kubo Y
First Department of Surgery, Asahikawa Medical College, Japan.
J Cardiovasc Surg (Torino). 1997 Aug;38(4):415-7.
The lesions of Takayasu's disease, which may involve the aorta and major arterial branches, may pose technical difficulties during coronary artery bypass grafting (CABG). Because the aorta is often thick and calcified, the coronary arterial lesion is often located near the coronary orifice, and the internal thoracic arteries may not be suitable for grafting due to the lesions in the subclavian arteries. A 63-year-old man with a known history of Takayasu's disease was referred to our department with chest pain complaint. Coronary angiography revealed obstruction of the left main coronary artery. CT scan showed that he had a thickened and calcified aorta. Aortography showed that both subclavian arteries had obstructive disease. Instead of using ordinary arterial grafts or vein grafts, a piece of prosthetic patch carrying saphenous vein grafts was sewn to the ascending aorta to construct the proximal anastomosis of CABG. Distal anastomosis was made on the left anterior descending artery and the obtuse marginal branch in the usual fashion. The patient showed uneventful recovery, and a postoperative coronary angiogram showed patent grafts and uncomplicated ventricular performance. This technique is useful when the aorta is not suitable for vein graft anastomosis and arterial grafts are not available as in this case with aortitis reported in the paper.
高安氏病的病变可能累及主动脉和主要动脉分支，在冠状动脉旁路移植术（CABG）过程中可能会带来技术难题。由于主动脉常常增厚并钙化，冠状动脉病变通常位于冠状动脉口附近，且由于锁骨下动脉病变，胸廓内动脉可能不适合用于移植。一名有高安氏病已知病史的63岁男性因胸痛主诉被转诊至我科。冠状动脉造影显示左主干冠状动脉阻塞。CT扫描显示他的主动脉增厚并钙化。主动脉造影显示双侧锁骨下动脉均有阻塞性病变。该患者未使用普通动脉移植物或静脉移植物，而是将一块携带大隐静脉移植物的人工补片缝至升主动脉以构建CABG的近端吻合。远端吻合以常规方式在左前降支动脉和钝缘支上进行。患者恢复顺利，术后冠状动脉造影显示移植物通畅且心室功能无并发症。当主动脉不适合进行静脉移植物吻合且如本文报道的主动脉炎这种情况下无法获得动脉移植物时，该技术是有用的。
