Radial Artery and Saphenous Vein Grafts in Coronary Artery Bypass Surgery Comparison in Terms of Patient Symptoms

Background: The aim of this study is to compare radial artery with saphenous vein grafts which are widely used for coronary bypass, from views of patients’ satisfaction and postoperative findings. Methods: 42 isolated coronary bypass (CABG) patients performed during November 2012-April 2013 are included in the study. 30 days after the operation, in patients who had both RA and SV removal made responses to a questionnaire form which included 6 questions about symptoms of extremity. Results: After analyzing the responses and physical examination, there was no difference in terms of quality of life and usefulness of the extremity for daily use between two grafts. 2 patients (2%) have wound infection on the saphenous vein incision and additional surgical procedure was performed and a scar tissue has occurred. There was no statistically significance between uncomfortable symptoms and demographic data. Conclusion: Our study suggested that RA graft using showed a bit more comfortable and suitable effect against SV in our patients. We think that radial arterial grafts should be used more widely in coronary surgery with selected patients.

Application of Endoscopic Vein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting

This study aims to evaluate the clinical outcomes of endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） in obese patients. Totally, 153 obese patients who underwent EVH （n=81） or standard bridging technique （SBT, n=72） in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups （P〉0.05）. There were no statistical differences in total operation time （226±28 min vs. 224±30 min, P〉0.05）, number of damaged vessels （0.12±0.05 vs. 0.16±0.06, P〉0.05） and short medium-term outcomes including revascularization rate （1.25% vs. 2.78%, P〉0.05）, vessel dysfunction rate （11.25% vs. 11.11%, P〉0.05） and mortality （0.00% vs. 0.00%, P〉0.05）. Use of EVH was associated with significant reduction of total harvesting time （41±6 min vs. 63±11 min, P〈0.05）, incision length （4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05） and postoperative lower extremity complications （P〈0.05）. EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.

The effect of endoscopic vein harvesting in coronary artery bypass surgery:association between vein harvesting techniques and quality of conduits,wound complications,and cardiovascular events

Objective The study aimed to compare quality of saphenous vein(SV)grafts,wound complications,and clinical outcomes between endoscopic vein harvesting(EVH)technique and open vein harvesting(OVH)technique of coronary artery bypass graft(CABG)surgery.Methods One hundred patients with multi-vessel coronary disease underwent elective CABG using SV grafts were prospectively recruited and randomized into two groups.

A huge thrombosed aneurysm of a saphenous vein graft leading to compression of cardiac structures： role of multimodality imaging

Aneurysmal change of saphenous vein grafts （SVG） is a rare condition that predominantly develops 10-20 years after coronary artery bypass graft （CABG）. Natural course includes mechanical complications due to mass effect, myocardial infarction and aneurysmal rupture. Aneurysmectomy can be considered when it induces such complications. We demonstrate complete set of diagnosis, treatment and post-operative imaging of a huge SVG aneurysm that was successfully treated with surgical resection.

A Comparative Analysis on Surgical Outcomes and Complications of Endoscopic and Open Vein Harvesting Techniques

Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.

Percutaneous coronary intervention of totally occluded coronary venous bypass grafts:An exercise in futility?

BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes.

Consideration of the Necessity of Prophylactic Bypass Grafting for Anomalous Origin of the Right Coronary Artery—Based on a Case with Concomitant Left Main Trunk Disease Resuscitated from Cardiopulmonary Arrest

Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.

Morbidity of Open Saphenous Vein Harvesting after Preoperative Ultrasonic Mapping

Preoperative echography of a saphenous vein graft (SVG) was studied. In 58 cases of consecutive coronary artery bypass grafting, 31 patients underwent SVG echography. Preoperative assessment revealed vein caliber, branching, or varicose saphenous veins. The location of the saphenous vein was marked. Saphenous veins were harvested by the open harvest technique, and the caliber of the veins and the availability of the anastomosis device were recorded. Postoperative morbidity was recorded. Preoperative findings revealed that four (6.5%) of 62 femoral saphenous veins were estimated as “not graftable” because of being a varicose vein or having a small caliber. Seven of 32 lower saphenous veins were estimated as “not graftable”. The mean discrepancy of the caliber was 0.6 mm undersized with preoperative estimation. During harvesting, one of 31 patients had a wrong marking. We were able to use all harvested veins. The morbidity of saphenous harvesting was observed in two (6.5%) of 31 patients. One patient whose marking was wrong had minor skin necrosis. Another patient experienced a hematoma because of the excess effect of warfarin. Preoperative ultrasonic mapping of the saphenous vein reduced useless harvesting, provided information concerning anastomosis device availability, and seemed to reduce morbidity because dissection can be minimal.

A Single Center Experience with Coronary Endarterectomy and Vein Patch Reconstruction

Background: To evaluate the medium and late term outcomes of coronary artery bypass grafting with pull-through coronary endarterectomy using a saphenous vein patch for bypass distal anastomosis site. Methods: Retrospective review of all coronary artery bypass graft (CABG) procedures performed from January 1, 2000 through June 30, 2013 with and without concomitant coronary endarterectomy (CE), was carried out at the Veterans Affairs Medical Center in Washington DC. Patients who underwent concomitant valve operations were excluded. Primary outcome was overall survival, with analyses performed examining CE as well as the use of cardiopulmonary bypass. Secondary outcomes included 30-day mortality and post-operative MI. Results: 1255 CABG operations were performed, 10 of which included CE. All CE procedures were performed with saphenous vein patch. 7 involved left anterior descending artery (LAD) CE with left internal mammary artery (LIMA) conduits. The remaining 3 were diagonal branch artery (D1) CE with saphenous vein bypass conduits. 1-year survival was 70%. 5-year survival was 43% out of 7 patients. Conclusions: Pull-through CE with saphenous vein patch is a safe alternative technique for patients with diffuse coronary artery disease. Perioperative events and intermediate outcomes are favorable, although long-term survival is less than patients without CE.

Relevance of SYNTAX score for assessment of saphenous vein graft failure after coronary artery bypass grafting

Objective::To identify risk factors of saphenous vein graft (SVG) failure and to investigate the utility of anatomical SYNTAX score (SS) and SYNTAX score II (SS-II) in predicting SVG failure.Methods::A total of 598 patients who underwent angiography for clinical reasons after coronary artery bypass grafting (CABG) were included. Baseline data and factors related to SVG failure were analyzed at the patient and graft levels. Patients were divided in tertiles by anatomical SS and in three groups by SS-II revascularization recommendation, and SVG patency was analyzed across these groups.Results::Patency rates were similar in all SS-stratified and SS-II recommendation groups within 1, 5, and 10 years after CABG. At the patient level, fasting blood glucose (FBG) level <7.0 mmol/L was less common in SVG failure (68.0% vs. 76.2%). At the graft level, patients with SVG failure tended to have angiography later (4.0 years vs. 3.0 years), poorer FBG control (FBG <7.0 mmol/L: 68.2% vs. 74.7%), and more grafts anastomosed to the right coronary system (59.2% vs. 47.4%). Longer time interval after CABG was related to SVG failure both at the patient and graft levels, and odds ratio ( OR)/ P values ( OR/ P) were 1.282/0.029 and 1.384/0.016, respectively. Using independent graft and grafting to the right artery system as risk factors at the graft level, OR/ Ps were 3.094/0.000 and 2.524/0.000, respectively. Conclusions::Longer time interval after CABG, independent grafts, and grafting to the right artery system are associated with SVG failure. Anatomical SS or SS-II may not be reasonable tools for predicting SVG failure.

Endoscopic vein harvest in elective off-pump coronary artery bypass grafting

While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hema-toma, pain scale, and superficial and deep wound infection. Coronary events were defined as diagnosis of myocardial infarction during the first year's follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preopera-tive risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complica-tions and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency.

经内窥镜大隐静脉获取术在冠状动脉旁路移植术中应用的学习曲线

【目的】探讨内窥镜获取大隐静脉在冠状动脉旁路移植术中的应用并探讨学习曲线,重点关注初学者易发生的问题及对早期临床结果的影响。【方法】回顾性分析2013年7月至2014年4月在郑州大学第一附属医院心外科接受不停跳冠状动脉旁路移植术并使用内窥镜技术获取大隐静脉的83例患者的临床资料,按照手术时间的先后顺序分为A组(初学组20例)、B组(熟悉组20例)、C组(进步组20例)、D组(成熟组23例),分析各组之间患者围术期及随访结果差异,明确学习曲线周期。【结果】该组患者年龄为(60.22±8.06)岁,体质量为(69.77±11.66)kg,其中合并高血压24例、糖尿病26例、亚急性脑梗14例。A组相对于后三组获取大隐静脉长度与时间比值明显较小(P<0.001),静脉主干损伤数量明显较多(P=0.006),并且随访1年时静脉桥通畅率较低,但差异无统计学意义。【结论】内窥镜获取大隐静脉之前技术操作培训是必要的,能有效规避初学者造成的血管损伤,实际获取的过程中大概需要亲自操作20例,并认真总结技术技巧就可以较为熟练地进行相关操作。

内窥镜采集大隐静脉对微创冠状动脉旁路移植术患者手术切口及生活质量的影响

目的 探讨内窥镜采集大隐静脉(EVH)在微创冠状动脉旁路移植术(MICABG)患者中对下肢手术切口及术后早期生活质量的影响。方法 分析2022年1月至12月我院及北京安贞医院单医疗组行微创冠状动脉旁路移植术患者共82例,内窥镜采集大隐静脉组(EVH)36例,开放采集大隐静脉组(OVH)46例。比较两组患者一般情况及术后下肢切口愈合不良、感染等方面的差异;应用SF-36生活质量量表比较两组患者术后早期生活质量的变化。结果 EVH组下肢手术切口愈合不良等并发症较少,在躯体疼痛、总体健康两个维度方面的改善率均优于OVH组(所有P<0.05)。结论 对于行微创冠状动脉旁路移植术的患者,内窥镜采集大隐静脉可减少下肢切口相关并发症,并能更好地提高患者术后早期的生活质量。

侵犯肾静脉的Castleman病误诊临床分析

目的探讨Castleman病(CD)的临床特点及鉴别诊断要点,以减少误诊误治。方法回顾性分析2023年收治的1例CD的临床资料,并复习相关文献。结果1例女性因发现腹腔占位10余天入院。入院完善相关检查,肿瘤标志物等未见异常。全腹部强化CT检查考虑畸胎瘤可能性大,腹膜后多发增大淋巴结。经多学科专家会诊后,行腹膜后病灶切除术、部分肾静脉切除术、肾静脉-下腔静脉自体大隐静脉搭桥术治疗,术后病理示CD,治愈出院。结论部分CD患者无明显临床表现,易误诊。临床鉴别CD与其他腹腔肿瘤时,应行多学科会诊并重视病理及免疫组织化学结果,仔细询问病史及查体,认真鉴别诊断,以减少或避免误诊误治。

非体外循环冠状动脉旁路移植术中大隐静脉单支桥和序贯桥的血流分析

目的:分析非体外循环冠状动脉旁路移植术(OPCAB)中大隐静脉(SV)单支桥和序贯桥的血流情况以及靶血管位置对血流的影响。方法:对2006年2月至2010年2月接受单一OPCAB手术的412例患者的464支SV桥进行回顾性分析,其中单支桥206支,双支序贯桥241支,三支序贯桥15支。比较SV单支、双支及三支桥的平均血流及搏动指数,以及单支与双支桥在不同靶血管上的血流情况。结果:SV双支和三支序贯桥的血流高于单支桥[分别为(43.4±22.5),(43.7±19.2)和(28.9±18.7)mL/min,P<0.001,P=0.047],双支和三支序贯桥之间无明显差别(P=0.96)。三者之间的搏动指数(PI)值无显著差异(分别为2.6±1.2,2.5±1.6,2.8±0.9,P=0.49)。以右冠主干为靶血管的SV单支桥血流高于后降支(P=0.047)和左室后支(P=0.042),收缩期血流时间高于对角支(P=0.003)、钝圆支(P=0.013)和后降支(P=0.002),而PI值低于后降支(P=0.033)和左室后支(P=0.032)。以对角支为靶血管的单支桥血流小于除左室后支外的其他冠状动脉分支(均P<0.05),以后降支-左室后支为靶血管的SV桥收缩期血流量显著低于以后降支-对角支和后降支-钝圆支为靶血管的SV桥。结论:SV双支和三支序贯桥的平均血流约为单支桥的1.5倍,对角支血流小于除左室后支外的其他冠状动脉分支。

老年人冠状动脉旁路移植术中桡动脉与大隐静脉应用的对比研究

目的:比较在60岁以上老年患者冠状动脉(冠脉)旁路移植术(CABG)中同时应用桡动脉与大隐静脉时的切口并发症及远期通畅率,探讨在老年冠心病患者中应用桡动脉的可行性。方法:回顾性分析2004-01至2010-01在我院同时采用桡动脉、大隐静脉行CABG的60岁以上冠心病患者资料,比较桡动脉与大隐静脉取材术后并发症的发生率及桥血管远期通畅率。共332例60岁以上CABG患者纳入本研究,平均(66.0±4.9)岁。桡动脉取材前均行多普勒超声,术后采用钙拮抗剂为主的抗痉挛策略。结果:住院期间死亡6例,死亡率1.8%。桡动脉取材术后切口疼痛、活动受限及血肿发生率与大隐静脉取材无统计学差异(P>0.05),但术后切口麻木、肿胀及感染发生率显著低于大隐静脉取材(P均<0.05)。至2012-12止,共完成随访307例,随访率92.5%,其中177例患者术后(58.0±23.7)个月选择性冠脉造影或多排冠脉计算机断层扫描术(CT)复查显示桡动脉桥通畅率为84.2%(149/177),显著高于大隐静脉桥通畅率(71.2%,126/177),P<0.05,差异均有统计学意义。结论:经过多普勒超声筛选及应用适宜的抗痉挛策略,在老年冠心病患者中应用桡动脉桥,可获得优于大隐静脉桥的临床效果,有望在老年CABG患者术中发挥重要作用。

微创内镜切取大隐静脉在冠状动脉搭桥术中的应用(附63例报告)

目的介绍微创内镜切取大隐静脉(MIEVH)在冠状动脉搭桥术(CABG)中应用的方法与临床效果。方法在连续CABG患者中,79例采用传统全程皮肤切口切取大隐静脉,63例采用MIEVH。结果微创术后腿部并发症明显减少,最显著的是切口无感染,下肢的疼痛和水肿明显减轻,切口小美容效果显著,优于传统全程SVG切口(P<0.05)。随访4～13个月(平均8.6个月),搭桥术后效果好。结论MIEVH安全可行,并发症少,美容效果显著,值得推广。

内镜下与常规切开法采集大隐静脉在冠状动脉旁路移植术中应用的比较

目的 探讨内镜下采集大隐静脉应用于冠状动脉旁路移植术（coronary artery bypass grafting, CABG）中的早期临床效果. 方法 2004年4月～2005年5月,对89例采用内镜下取大隐静脉行CABG（内镜组）,在膝关节中部做2 cm切口,应用VasoView 5内镜血管采集系统游离获取大隐静脉,并与2003年4月～2005年3月38例采用传统切开法取大隐静脉行CABG（常规组）进行比较,比较2组术后下肢切口并发症、恢复行走时间、患肢疼痛麻木感及肿胀、术后6个月通畅率.结果 内镜组取大隐静脉2～3支,平均2.6支;内镜组下肢并发症（6例）与常规组（8例）相比明显减少（χ^2=4.197,P＝0.040）;内镜组患肢疼痛、麻木感7例及肿胀9例与常规组（分别为36、30例）相比明显减少（χ^2=89.740,P＝0.000;χ^2=59.299;P＝0.000）;内镜组恢复行走时间（2.3±0.9） d比常规组（3.4±1.6） d明显缩短（t=-4.952,P=0.000）;内镜组术后6个月通畅率96.0%（48/50）与常规组95.3%（19/20）相比无明显差别（χ2=0.000,P=1.000）. 结论 CABG中应用内镜下采集大隐静脉能够减少创伤,明显降低术后下肢并发症,减轻术后下肢切口疼痛.

非体外循环冠状动脉旁路移植术中不同方式获取大隐静脉的近中期临床效果

目的分析非体外循环冠状动脉旁路移植术(OPCABG)不同方式获取大隐静脉的近期和中期临床效果。方法选择在我科接受择期OPCABG的患者435例,根据获取大隐静脉的方式,分为内窥镜获取大隐静脉(edoscopic vein harvesting,EVH)组217例及开放式获取大隐静脉(open vein harvesting,OVH)组218例,比较2组围术期病死率、急性心肌梗死、低心排综合征和腿部切口并发症等不良事件发生率,随访6个月和1年,比较2组静脉桥血管狭窄或闭塞比例和腿部切口并发症。结果 EVH组围术期腿部切口并发症发生率明显低于OVH组(2.30%vs 12.84%,P=0.000)。EVH组与OVH组围术期病死率(1.38%vs 2.29%,P=0.724)、急性心肌梗死(1.38%vs1.83%,P=1.000)和低心排综合征发生率(1.84%vs 2.75%,P=0.751)比较,差异均无统计学意义。术后6个月随访,EVH组与OVH组发生桥血管狭窄或闭塞比例比较,差异无统计学意义(8.76%vs 9.17%,P=1.000),EVH组腿部切口相关并发症发生率明显低于OVH组(3.69%vs 17.89%,P=0.000)。术后1年随访,EVH组与OVH组发生桥血管狭窄或闭塞比例比较,差异无统计学意义(11.52%vs 14.22%,P=0.475),EVH组腿部切口相关并发症发生率明显低于OVH组(5.53%vs 25.69%,P=0.000)。结论 EVH与OVH围术期不良事件发生率相似,但EVH术后腿部切口相关并发症发生率低于OVH,较OVH有明显优势。