冠状动脉旁路移植术后心绞痛的冠状动脉造影分析

Arteriographic evaluation of graft patency in patients with reccurrence of angina after CABG

目的 了解自体血管和移植血管随时间产生的变化与心绞痛复发的关系 ,探讨治疗方法。方法 4 8例冠状动脉旁路移植 (CABG)术后的患者因心绞痛复查冠状动脉造影 ,检查自体血管和移植血管的情况。结果 4 8例患者中男性 4 2例 ,女性 6例 ,平均年龄 6 2 8± 9 9岁。CABG到冠状动脉造影时间 :1～ 6个月 4 7 9% (2 3 4 8) ;7～ 12个月 2 0 8% (10 4 8) ,1年以上者 31 3% (15 4 8)。 135支移植血管中 ,闭塞 33 3% (4 5 135 ) ,狭窄 5 9% (8 135 ) ;其中左乳内动脉 (LIMA)闭塞 2 8 6 % (10 35 ) ,吻合口狭窄 8 6 % (3 35 ) ,血流竞争不过自体血管 8 6 % (3 35 ) ;静脉桥狭窄 5 2 % (5 97) ,闭塞 35 1% (34 97)。 3例桡动脉搭桥中 2例有狭窄。心绞痛复发可能的原因 :移植血管病变 72 9% (35 4 8) ,自体血管病变加重 8 3% (4 4 8) ,再血管化不完全 12 5 % (6 4 8) ,移植血管在狭窄近端 1例 ,左锁骨下动脉起始部严重狭窄导致LIMA供血不足 1例。药物治疗 2 5例 ;自体血管介入治疗 15例 ,5例慢性闭塞失败 ;6例桥血管狭窄介入治疗成功 ;2例再CABG。结论 CABG术后仍可以复发心绞痛 ,复发的主要原因是移植血管病变 ,其次为自体血管病变加重 ,再血管化不完全 ,搭桥位置不正确。

Objective To identify the causes of recurrence of angina after CABG. Methods Fourty-eight patients with recurred angina underwent coronary arteriography with standard technique to evaluate the native vessels and grafts. Results Of the 48 patients, 42 were male and 6 were female. The average age was 62.8±9.9 years. The time from CABG to coronary arteriography was within 6 months in 47.9% (23/48) of the patients, between 7～12 months in 20.8% (10/48), >12 months in 31.3% (15/48). The graft lesions were found in 72.9% (35/48) of the patients, the worsened native lesions in 8.3% (4/48) and incomplete revascularization in 12.5% (6/48). Total occlusion was found in 33.3% (45/135) of the grafts and stenosis in 5.9% (8/135). LIMA total occlusion was 46.4% (13/28), stenosis was 8.6% (3/35) and competitive flow was 8.6% (3/35). Stenosis was found in 5.2% (5/97) of the SVG and total occlusion in 35.1% (34/97). Two of the five radial arteries were stenotic. Except for the chronic total occlusions, PCI treated the above problems with a high success rate. Conclusion Reoccurrence of angina is not uncommon after CABG. The causes are mainly due to the graft problem, and secondly due to worsened native lesion and incomplete revascularization. PCI can be used to treat the above problems except for the chronic total occlusions of the native vessels and graft.