MORPHOLOGIC FINDINGS IN SAPHENOUS VEINS USED AS CORONARY ARTERIAL BYPASS CONDUITS FOR LONGER THAN 1-YEAR - NECROPSY ANALYSIS OF 53 PATIENTS, 123 SAPHENOUS VEINS, AND 1865 5-MILLIMETER SEGMENTS OF VEINS
MORPHOLOGIC FINDINGS IN SAPHENOUS VEINS USED AS CORONARY ARTERIAL BYPASS CONDUITS FOR LONGER THAN 1-YEAR - NECROPSY ANALYSIS OF 53 PATIENTS, 123 SAPHENOUS VEINS, AND 1865 5-MILLIMETER SEGMENTS OF VEINS
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DOI：
10.1016/s0002-8703(05)80249-2
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发表时间：
1990-05-01
影响因子：
4.8
通讯作者：
ROBERTS, WC
中科院分区：
文献类型：
--
作者：
KALAN, JM;ROBERTS, WC
本文描述了53例单次冠状动脉旁路手术后13 ~ 185个月（平均58个月）死亡的患者的某些临床和尸检结果。在53例患者中，32例（60%）死于心脏原因，他们的72条隐静脉主动脉冠状动脉导管中，36例（49%）因动脉粥样硬化斑块在某一点狭窄，其横截面积超过75%；其余21例患者（40%）死于非心脏原因，在他们的50条隐静脉导管中，10例（20%）在某些点被斑块狭窄，其截面积超过75%。因此，大部分患者的非心脏死亡方式表明，搭桥手术延长了生命，足以使另一种疾病的发生。将123条隐静脉导管分成5分钟段，每段分别制作组织学切片。在32例因心肌缺血死亡的患者的1104个5毫米节段中，有291个（26%）的横截面积被斑块缩小了75%以上；相比之下，在21例非心源性死亡患者的761个5毫米静脉段中，86例（11%）因斑块狭窄超过7%。在1865个5毫米静脉段中，只有395个（21%）被斑块截面积缩小25%或更小。因此，在冠状动脉搭桥术后晚期死亡的患者中，作为冠状动脉导管的隐静脉的所有节段的动脉粥样硬化过程仍在继续。手术后的治疗必须针对预防“新”冠状动脉粥样硬化的进展。
Certain clinical and necropsy findings are described in 53 patients who died from 13 to 185 months (mean 58) after a single aortocoronary bypass operation. Of the 53 patients, 32 (60%) died of a cardiac cause and of their 72 saphenous vein aortocoronary conduits, 36 (49%) were narrowed at some point more than 75% in cross-sectional area by atherosclerotic plaque; the remaining 21 patients (40%) died of a noncardiac cause and of their 50 saphenous vein conduits, 10 (20%) were narrowed at some point more than 75% in cross-sectional area by plaque. Thus the noncardiac mode of death in a large percentage of the patients suggests that the bypass operation prolonged life to a degree sufficient for another condition to develop. The 123 saphenous vein conduits were divided into 5 min segments, and a histologic section was prepared from each. Of the 1104 five-millimeter segments in the 32 patients dying as a consequence of myocardial ischemia, 291 (26%) were narrowed more than 75% in cross-sectional area by plaque; in contrast, of the 761 five-millimeter segments of veins in the 21 patients with a noncardiac mode of death, 86 (11%) were narrowed more than 7% by plaque. Of the total 1865 five-millimeter segments of vein, only 395 (21%) were narrowed 25% or less in cross-sectional area by plaque. Thus, in patients dying late after coronary bypass the atherosclerotic process continues in all segments of the saphenous veins used as aortocoronary conduits. Therapy after the operation must be directed toward prevention of progression of the atherosclerosis in the "new" coronary "arteries".