桡动脉在冠状动脉旁路移植术中的应用

Role of Radial Artery Graft in Coronary Artery Bypass Grafting

桡动脉(RA)作为冠状动脉旁路移植术(CABG)的移植血管已广泛应用,但在其获取、手部侧枝循环的评估、抗痉挛措施、靶血管选择、以及近端吻合口等方面尚未统一的认识。一般认为RA应当连同周围的伴行静脉血管一起获取并且优先用于严重狭窄(>70%)的冠状动脉。RA近端可以吻合于升主动脉,或者与左侧或右侧乳内动脉一起构成复合移植血管。RA作为移植血管的通畅率主要取决于靶血管狭窄的严重程度和靶血管的位置,而不是取决于近端吻合于主动脉或是乳内动脉。尽管缺乏实验证据,许多研究者提倡预防性抗痉挛治疗。在全动脉化冠状动脉旁路移植的患者中应用RA取代右侧乳内动脉作为第二选动脉移植血管具有优势。

Though the use of the radial artery （RA） as a coronary artery bypass graft has been accepted world widely in myocardial revascularization, there has been no uniformity regarding harvest techniques, assessment of the adequacy of hand collateral circulation, antispasm protocols, selection of target vessels, and the site of proximal anastomosis. It is widely believed and practiced that the RA should be harvested as a pedicle graft and preferably be used to bypass critically stenosed （〉70% stenosis） coronary arteries. It is used either as a free graft with proximal anastomosis to the ascending aorta or as a composite arterial graft along with the left or right internal thoracic artery. The patency of RA grafts depends on the severity of the target coronary artery stenosis and target artery location rather than its use as an aortocoronary conduit or composite graft. Though lacking of evidences, most surgeons use antispasm therapy for RA conduits. There are advantages in using RA as an alternative for right internal mammary artery in total artery coronary revascularization.