The Alternatives of Autologous Arterial Grafts for Coronary Bypass Surgery

冠狀動脈繞道手術中自體動脈性繞道血管的選擇

袁師敏(Shi-Min Yuan) ； 欣菲爾德•阿米海(Amihay Shinfeld) ； 卡哈勒•埃萊茲(Erez Kachal) ； 拉納尼•烏迪(Ehud Raanani)

《Acta Cardiologica Sinica》 22卷3期 (2006/09) Pp. 121-133

摘要

本文透過MEDLINE資訊收集，將針對冠狀動脈繞道手術中自體動脈性繞道血管作全面概括的探討。搜尋主題包括動脈性繞道血管和冠狀動脈繞道手術。對於常用的動脈性繞道血管，包括內乳動脈(IMA)、橈動脈、右胃網膜動脈和腹壁下動脈，相關文章進行選取並顯示形態學特徵、與通暢率上的差異並比較其優缺點。對於少數零星病案報導的動脈性繞道血管，例如肩胛下動脈、尺動脈、脾動脈和側肋動脈也進行廣泛收集。
搜尋結果發現：左右雙側pedicled內乳動脈有相似的通暢率。Pedicled內乳動脈比游離的內乳動脈繞道血管有較高的通暢率。然而胸骨感染的發生與患者使用雙側內乳動脈有關。Skeletonized內乳動脈雖提供更好的胸骨灌注，但會造成局部血管壁傷害。繞道吻合於低度狹窄或非左前降支的冠狀動脈將增加內乳動脈繞道血管失敗的風險。內乳動脈比其他動脈性繞道血管的通暢率上的優勢可歸結於它優越的內皮細胞作用及血流重建。內乳動脈屬於彈力性的血管，而其他是肌性的血管。而內乳動脈的20年的通暢率為88.9%，橈動脈的5年的通暢率為85%，右胃網膜動脈的5年的通暢率為85.7%，腹壁下動脈在術後21.2月的通暢率為52.2%。其他的動脈性繞道血管亦有少許報告，並顯示良好的結果。
所以冠狀動脈繞道手術中自體動脈性繞道血管的選擇，首選是左側IMA，其次為右側IMA，橈動脈則為第三優先選擇。而其他動脈亦可作為替代選擇。

關鍵字

動脈性繞道血管 ； 冠狀動脈繞道手術 ； 通暢率

並列摘要

A survey is made to autologous arterial grafts for coronary arterial bypass grafting.
Articles were collected by searching MEDLINE database. Search terms included arterial graft and coronary bypass. Reports regarding the commonly used arterial grafts, including the internal mammary artery (IMA), as well as the radial, right gastroepiploic, and inferior epigastric arteries, were screened in order to highlight their morphologic characteristics, patency rates, advantages and drawbacks, while a comprehensive collection was made on those grafts with merely a scattering of cases, such as the subscapular, ulnar, splenic, and lateral costal arteries. The patency rate of pedicled left and right IMAs were similar. Pedicled IMA had a higher patency than free IMA graft. Higher incidence of sternal infection was found in patients with bilateral IMAs bypassed. A skeletonized IMA would supply a better sternal perfusion, but may cause a focal injury during harvest. An increased risk of graft failure of the IMA is associated with grafting low-grade stenosed or non-left anterior descending coronary arteries. The superiority of the IMA over other conduits might be due to its superior endothelial function and flow remodeling. The IMA is elastic, while others are muscular. The patency rates were 88.9% for the IMA at 20-year, 85% for the radial artery at 5-year, 85.7% for the right gastroepiploic artery at 5-year, and 52.2% for the inferior epigastric artery at 21.2-month follow-up, respectively. Other grafts had fewer reports, but showed good results. In the graft selection for coronary bypass, the primary choice is the left IMA; the second choice is the right IMA; and the radial artery is the third choice. Other arteries could be used as additional grafts.

並列關鍵字

Arterial graft ； Coronary bypass ； Patency rate