静脉桥病变的介入治疗及临床预后观察

Clinical outcomes of percutaneous intervention for sapheneous vein graft lesions

目的:本文针对不同部位桥血管病变的介入特点及临床预后进行比较探讨。方法:入选2005年12月至2011年12月,行静脉桥血管(SVG)介入治疗的患者68例。共73处SVG病变,其中位于主动脉-静脉桥开口14处,体部病变39处,远端病变20处。随访联合终点事件包括:急性心肌梗死,靶血管闭塞及再狭窄(TVF),心源性死亡。结果:平均桥血管病变发生时间为冠状动脉搭桥术后(6.72±4)年。1年以内的发生的桥血管病变大部分为远端吻合口病变(54.5%)。经皮冠状动脉介入术的介入成功率为94.5%,以体部病变成功率最高达100%,主动脉-静脉桥开口的成功率最低为85.7%。远端保护器应用在体部病变中应用比率最高(30.8%,P<0.01),远端吻合口病变所需支架直径最小(3.26±0.57)mm,P<0.05。主动脉-静脉桥开口病变所需支架的后扩张压力最大(17.8±2.3)atm(1atm=101.325 kPa),P<0.05。平均随访24.37个月,共发生终点事件17例(23.3%)。以主动脉-静脉桥开口最为多见6例(42.9%)。结论:SVG的经皮介入治疗可行,主动脉-静脉桥开口病变的介入成功率较低,远期预后较差。

Objective：In this study,we sought to investigate the procedure characteristics and long term follow up of percutaneous coronary incervention（PCI） for saphenous vein graft（SVG） lesions.Methods： From Dec.2005 to Dec.2011,Seventy three graft lesions were treated percutaneously.14 located at proximal anastomosis,39 located at SVG body,20 located at distal anastomosis.Primary endpoint was defined as（Cardiac death,target vessel failure,acute myocardial infarction）.Results： The graft age was（6.72±4）years old.More patients in distal anastomosis group presented with occluded graft within one year post CABG（54.5%）.Proximal anastomosis lesion had lowest successful rate for PCI compared with graft body and distal anastomosis lesions（85.7%,vs 100%,90%,P0.05）,Distal protection device was used more frequently in body graft PCI（30.8%,P0.01） group.The diameter of the stent was smallest in distal anastomosis group [（2.7±0.52）mm P0.05] The proximal anastomosis need highest post dilatation pressure [（17.8±2.3） atm,P0.05].Patient was followed up for 24.3 months.Primary end point occurred in 23.3% of patients.Proximal anastomosis had highest rate（42.9% P0.05）.Conclusion： Percutaneous treatment of osital graft anastomosis had lowest procedure successful rate and highest event rates in compare with graft body and distal anastomosis lesions.