Lumen loss in the first year in saphenous vein grafts is predominantly a result of negative remodeling of the whole vessel rather than a result of changes in wall thickness
Lumen loss in the first year in saphenous vein grafts is predominantly a result of negative remodeling of the whole vessel rather than a result of changes in wall thickness
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DOI：
10.1161/circulationaha.105.001008
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发表时间：
2006-07-04
期刊：
影响因子：
37.8
通讯作者：
Kritharides, Leonard
中科院分区：
文献类型：
--
作者：
Lau, George T.;Ridley, Lloyd J.;Kritharides, Leonard
背景-大隐静脉移植物（SVG）在冠状动脉搭桥手术中的应用已经建立，但对第一年体内 SVG 重塑知之甚少。方法和结果-在体模模型管（管腔直径 r = 0.98，壁厚 r = 0.98）中建立了通过新型计算机断层扫描（CT）方法测量总血管直径（管腔加管壁）、管腔直径和管壁厚度的可行性，并在初步临床研究中建立了14 名患者将 SVG 的 CT 和血管内超声测量相关联（总血管直径 r = 0.88，管腔直径 r = 0.85，壁厚度 r = 0.89）。在另一组 42 名接受冠状动脉旁路移植术的患者（年龄 66 +/- 10 岁；36 名男性，6 名女性）中，在术后 1 个月和 12 个月通过多层 CT 血管造影前瞻性确定 SVG 总血管直径、管腔直径和壁厚度。平均总血管直径从 5.95 +/- 0.83 mm 降至 5.39 +/- 0.87 mm，P < 0.001（范围，-39% 至 +8% 变化）。 26 名患者 (62%) 的 SVG 血管直径减少（负重塑）> 5%。平均内腔直径从 3.69 +/- 0.66 mm 下降至 3.36 +/- 0.68 mm，P < 0.001（范围，-40 至 + 11% 变化）。令人惊讶的是，平均壁厚从 1.14 +/- 0.27 mm 下降至 1.01 +/- 0.21 mm（P < 0.001；范围为 -48 至 + 33% 变化）。结论 - 术后第 1 个月至 12 个月期间 SVG 管腔损失主要是由整个血管的负重塑引起的，而不是壁厚的变化。为了在术后第一年实现 SVG 管腔的最佳维持，可能需要针对负重塑的治疗。
Background-The use of saphenous vein grafts (SVG) in coronary artery bypass surgery is established but little is known of SVG remodeling during the first year in vivo.Methods and Results-The feasibility of measuring total vessel diameter (lumen plus wall), lumen diameter, and wall thickness by a novel computed tomography (CT) method was established in phantom model tubes (r = 0.98 for lumen diameter and r = 0.98 for wall thickness) and in an initial clinical study of 14 patients correlating CT and intravascular ultrasound measurements of SVG (r = 0.88 for total vessel diameter, r = 0.85 for lumen diameter and r = 0.89 for wall thickness). In a separate group of 42 patients (aged 66 +/- 10 years; 36 male, 6 female) undergoing coronary artery bypass grafting, SVG total vessel diameter, lumen diameter, and wall thickness were determined prospectively with multi-slice CT angiography at 1 and 12 months postoperatively. Mean total vessel diameter decreased from 5.95 +/- 0.83 mm to 5.39 +/- 0.87 mm, P < 0.001 (range, -39% to +8% change). Twenty-six patients (62%) had a decrease of SVG vessel diameter (negative remodeling) > 5%. Mean lumen diameter decreased from 3.69 +/- 0.66 mm to 3.36 +/- 0.68 mm, P < 0.001, ( range, -40 to + 11% change). Surprisingly, mean wall thickness decreased from 1.14 +/- 0.27 mm to 1.01 +/- 0.21 mm (P < 0.001; range, -48 to + 33% change).Conclusions-Lumen loss in SVG between postoperative months 1 and 12 is predominantly caused by negative remodeling of the whole vessel rather than to changes in wall thickness. Therapies targeting negative remodeling may be required for optimal maintenance of SVG lumen in the first postoperative year.