Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery:: Results of a randomized longitudinal trial
Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery:: Results of a randomized longitudinal trial
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DOI：
10.1016/j.jtcvs.2006.04.002
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发表时间：
2006-08-01
影响因子：
6
通讯作者：
Dashwood, Michael R.
中科院分区：
文献类型：
--
作者：
Souza, Domingos S. R.;Johansson, Benny;Dashwood, Michael R.
目的：在冠状动脉搭桥术中，传统的隐静脉采集会造成血管损伤，导致移植物失败。一种新颖的“无接触”技术提供了高的短期和长期通畅率。方法：该随机纵向试验比较两组接受冠状动脉搭桥术患者的移植物通畅程度。常规：52例患者静脉剥离，扩张，并保存在生理盐水溶液中。无接触：52例患者将静脉与周围组织一起切除，不扩张，并储存在肝素化的血液中。常规组46例、非接触组45例术后平均18个月进行血管造影评估，两组37例术后平均8.5年进行血管造影评估。结果：两组冠状动脉内移植物的大小和质量分布相似。术后18个月的血管造影评估显示89%的常规移植物和95%的无接触移植物是通畅的。8.5年复查血管造影显示常规组通畅率为76%，无接触组通畅率为90% （P = 0.01）。多因素分析显示，影响移植物通畅的最重要的手术因素是无接触技术与常规技术的收获技术（优势比为3.7,P =.007）和植入前静脉质量（优势比为3.2,P =.007）。相比之下，胸动脉移植通畅率为90%。结论：与左胸内动脉相比，切除隐静脉及周围组织可提供较高的短期和长期通畅率。
Objective: Conventional harvesting of the saphenous vein in coronary artery bypass surgery produces vessel damage that contributes to graft failure. A novel "no touch" technique provides high short- and long-term patency rates.Method: This randomized longitudinal trial compares graft patency of two patient groups undergoing coronary artery bypass surgery. Conventional: 52 patients had their veins stripped, distended, and stored in saline solution. No-touch: 52 patients had veins removed with surrounding tissue, not distended, and stored in heparinized blood. Angiographic assessment was performed at mean time 18 months after the operation in 46 patients in the conventional group and 45 patients in the no-touch group and repeated at mean time 8.5 years in 37 patients from both groups.Results: The distribution of the grafts to the recipient coronary arteries regarding their size and quality was similar in both groups. The angiographic assessment at 18 months postoperatively showed 89% conventional versus 95% no-touch grafts were patent. Repeated angiography at 8.5 years showed a patency rate for the conventional group of 76% and 90% for the no- touch group ( P =.01). The multivariate analysis showed that the most important surgical factors for graft patency were the technique of harvesting ( odds ratio = 3.7, P =.007) for the no- touch versus the conventional technique and the vein quality before implantation ( odds ratio = 3.2, P =.007) for veins that were of good quality. By comparison the patency of the thoracic artery grafts was 90%.Conclusion: Harvesting the saphenous vein with surrounding tissue provides high short- and long-term patency rates comparable to the left internal thoracic artery.