Sudhakar C B, Forman D L, Dewar M L, Shaw R K, Fusi S
Division of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
Ann Plast Surg. 1998 Apr;40(4):408-11; discussion 412. doi: 10.1097/00000637-199804000-00015.
In the search for alternative conduits, the use of radial artery (RA) grafts has found renewed interest. This study sought to evaluate prospectively the perioperative morbidity, including the postoperative complications in the donor forearm, and mortality in the routine use of RA grafts in coronary artery bypass surgery. Data were obtained prospectively on 200 consecutive patients who underwent coronary revascularization using at least one RA graft from January 1995 to April 1997. The mean age of the patents was 61.9+/-10.5 years (mean+/-standard deviation [SD]). The RA was obtained from one forearm in 197 patients and both forearms in 3 patients. Two patients (1%) required exploration for donor site hematomas, 4 patients (2%) had temporary perioperative dysesthesias in the region of the lateral cutaneous nerve of the forearm, and none had donor site wound infection. Two patients (1%) had a myocardial infarction with electrocardiographic changes in the areas grafted by the RA in the immediate postoperative period, indicating graft failure. The two deaths in the series were due to comorbid factors. Our data suggest that the RA is a safe and suitable conduit for coronary revascularization, and it provides good clinical results. Long-term follow-up of these patients is necessary to confirm the patency of RA conduits. Free RA grafts have the potential for use in other areas of surgery where a conduit is necessary for revascularization procedures.
在寻找替代血管通道的过程中,桡动脉(RA)移植物的使用重新引起了人们的兴趣。本研究旨在前瞻性评估围手术期发病率,包括供体前臂的术后并发症,以及冠状动脉搭桥手术中常规使用RA移植物的死亡率。前瞻性收集了1995年1月至1997年4月期间连续200例行冠状动脉血运重建且至少使用一根RA移植物的患者的数据。患者的平均年龄为61.9±10.5岁(均值±标准差[SD])。197例患者的RA取自一侧前臂,3例患者的RA取自双侧前臂。2例患者(1%)因供体部位血肿需要探查,4例患者(2%)在前臂外侧皮神经区域出现围手术期短暂感觉异常,无一例发生供体部位伤口感染。2例患者(1%)在术后即刻出现心电图改变的心肌梗死,提示移植物失败。该系列中的2例死亡是由合并症因素导致的。我们的数据表明,RA是一种安全且合适的冠状动脉血运重建血管通道,并且能提供良好的临床效果。对这些患者进行长期随访以确认RA血管通道的通畅情况是必要的。游离RA移植物有可能用于其他需要血管通道进行血运重建手术的领域。