64层螺旋CT评价冠状动脉搭桥术后桥血管通畅性的变化

Evaluation of grafts patency changes after coronary artery bypass grafting with 64 multi-detector computed tomography

目的使用64层多排螺旋CT(MDCT)评价冠状动脉搭桥术后左内乳动脉(LIMA)桥血管和大隐静脉(SV)桥血管通畅性的变化。方法从2012年3月至2015年3月,146例患者实施了冠状动脉搭桥手术和术后MDCT系列随访观察。比较早期(平均间隔5.2个月)与晚期(平均间隔21.6个月)的术后表现。共评价了143个LIMA桥血管和184个SV桥血管。结果在早期的MDCT中,LIMA和SV桥血管的通畅率分别是93.0%和92.9%。在晚期的MDCT中,LIMA和SV的通畅率分别是90.0%和87.5%。与早期MDCT相比,5例患者的5个LIMA桥血管(4支吻合到前降支,1支吻合到右冠)和8例患者的10支SV桥血管(4支吻合到对角支、3支吻合到右冠版图、1支吻合到钝缘支、2支序贯吻合到钝缘支和右冠版图)通畅性发生了恶化。对于LIMA桥来说,吻合到前降支和吻合到右冠通畅性的恶化没有区别(P=0.2)。对于SV桥来说,吻合到不同的靶血管,桥血管通畅性的恶化有接近统计学意义的区别(P=0.05),特别是吻合到对角支和钝缘支(P=0.02)。结论在系列MDCT检查中,LIMA和SV桥血管的通畅性随着时间延长而降低。对于SV桥血管来说,吻合到对角支通畅性的恶化率最高。

patency changes Objective To assess the left internal with time after coronary artery bypass mammary artery （LIMA） and grafting （ tomography（MDCT）. Methods From March 2012 to March 2015 saphenous vein （ SV ） grafts CABG） by using 64 multi-detector computed ,146 patients underwent CABG operation and postoperative serial 64-MDCT follow-up. The early postoperative （ mean interval 5.2 months ） 64-MDCT findings of these patients were compared with the late MDCT findings（ average 21.6 months）. A total of 143 LIMA and 184 SV grafts with 384 distal anastomoses were assessed. Results In the early MDCT, the patencies were 93.0% and 92. 9% for LIMA and SV grafts,respectively. In the late MDCT,the corresponding values were 90. 0% and 87.5%. Compared with the early MDCT, deterioration in graft patency occurred in 5 LIMA grafts （4 anastomosed to LAD and 1 anastomosed to RCA）in 5 patients and 10 SV grafts （4 anastomosed to D, 3 anastomosed to RCA territory, 1 anastomosed to OM, 2 sequentially anastomosed to OM and RCA territory） in 8 patients. There was no patency deterioration difference between anastomosed to LAD and RCA territory （ P = 0. 2） for LIMA graft. For SV conduits,there was nearly significant difference of patency deterioration among anastomosed to D, OM, RCA territories and sequential anastomosis （P = 0.05 ）, especially anastomosed to D and OM （ P = 0. 02 ）. Conclusion LIMA and SV graft patency decrease with time on serial MDCT. There is higher patency deterioration anastomosed to D for SV conduits.