冠状动脉旁路移植术后移植静脉再狭窄的防治现状

The Prevention of Restenosis in Vein Grafts after Coronary Artery Bypass Grafting

冠状动脉旁路移植术(CABG)是冠状动脉粥样硬化性心脏病的常规治疗方法之一,动脉血管作为移植血管材料有其自身优势,但对大多数患者而言,自体大隐静脉仍然是最常用的移植血管材料,然而静脉移植后10年闭塞率高达50%余通畅的移植静脉也常有严重的病变,移植静脉的远期通畅率低已成为CABG疗效的瓶颈,新内膜形成和动脉粥样硬化导致移植静脉再狭窄已成为一个亟待解决的问题。目前,针对移植静脉再狭窄过程中的分子学机制和病理发展过程,研究者均采取了不同的防治方法,主要包括药物治疗、血管外支架、静脉保存液改进和基因治疗等,与其它方法相比较,基因治疗移植静脉再狭窄具有广阔的前景。我们对移植静脉再狭窄的防治和展望进行综述。

Coronary artery bypass grafting（CABG） is one of the conventional treatments of coronary artery disease.Though the artery grafts have its own superiority,autologous great saphenous vein is still commonly used.Ten years after operation,half of the vein grafts will be occluded and half of the remainder will often undergo severe pathological conditions.The poor long term patency of vein grafts has become the bottleneck of the efficiency of CABG.The restenosis of vein grafts resulting from neointima and atherosclerosis has become an urgent problem waiting to be resolved.As the study on the molecular mechanism and pathophysiology of the vein grafts disease develops,many therapeutic schedules have been made,including drug therapy,external stent, expanding solution and gene therapy.By contrast,gene therapy has a broader prospect.This article will have a review on the prevention of restenosis of the vein grafts after CABG.