Kobayashi T, Makuuchi H, Naruse Y, Sato T, Fujiki T, Ninomiya M, Ogata K, Komiyama N
Division of Cardiovascular Surgery, Toranomon Hospital, Tokyo, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Aug;46(8):701-6. doi: 10.1007/BF03217805.
The wall characteristics of saphenous vein grafts (SVGs) after coronary artery bypass grafting (CABG) were assessed with intravascular ultrasound (IVUS) imaging. Twenty-seven SVGs in 25 patients who had undergone CABG were studied with IVUS in vivo. Ten SVGs excised from 6 patients who had undergone reoperation were studied with IVUS in vitro. The results were compared with the histopathologic findings. IVUS images of four SVGs studied within 1 month after CABG showed a thin and single-layer structure, which was almost identical to the IVUS features of a normal, fresh SVG. In five SVGs studied between 3 months and 1 year after CABG, the wall thickness was increased, and there were hypoechoic areas. In sixteen SVGs studied more than 2 years after CABG, two patterns were noted on IVUS imaging. One pattern was a triple-layer structure of alternating hyperechoic, hypoechoic, and hyperechoic bands seen in the angiographically normal sections of the SVGs. The second pattern was a heterogeneous, echogenic monolayer found in the angiographically irregular and diseased sections of the SVGs. Comparison of the in vitro IVUS images with the histopathology of the SVGs showed a strong correlation between the triple-layer structure and fibrointimal proliferation, and between the heterogeneous monolayer and atherosclerosis. In conclusion, IVUS is useful for assessing SVGs and for long-term qualitative monitoring of vein graft disease after CABG.
采用血管内超声（IVUS）成像评估冠状动脉旁路移植术（CABG）后大隐静脉移植物（SVG）的管壁特征。对25例行CABG患者的27条SVG进行了体内IVUS研究。对6例再次手术患者切除的10条SVG进行了体外IVUS研究。将结果与组织病理学结果进行比较。CABG后1个月内研究的4条SVG的IVUS图像显示为薄的单层结构，这与正常新鲜SVG的IVUS特征几乎相同。在CABG后3个月至1年研究的5条SVG中，管壁厚度增加，出现低回声区。在CABG后2年以上研究的16条SVG中，IVUS成像观察到两种模式。一种模式是在SVG血管造影正常的节段中可见高回声、低回声和高回声带交替的三层结构。第二种模式是在SVG血管造影不规则和病变节段中发现的不均匀、回声增强的单层结构。体外IVUS图像与SVG组织病理学的比较显示，三层结构与纤维内膜增生之间以及不均匀单层与动脉粥样硬化之间存在很强的相关性。总之，IVUS有助于评估SVG，并对CABG后静脉移植物疾病进行长期定性监测。
