目的 回顾单中心12年应用桡动脉行冠状动脉再血管化经验.方法 2001年6月至2013年6月,93例接受桡动脉-冠状动脉旁路移植术的冠心病患者,男87例,女6例;年龄28～66,平均49.9岁.术前冠状动脉造影示单纯左主干狭窄2例,合并左主干病变39例;双支血管病变2例,三支病变89例.共获取桡动脉118支,其中左侧前臂67支,右侧前臂1支,双侧前臂25例50支.结果 体外循环下旁路移植92例,非体外循环下1例.旁路移植2～6,平均2.9支.手术死亡1例,心肌梗死2例.旁路移植材料血管除桡动脉外,所有患者常规使用内乳动脉,部分患者同时使用了大隐静脉.92例生存活患者症状消失或减轻,心功能改善.术后随访3～ 139个月,平均59个月,造影或冠脉CT示桡动脉通畅率为93.1％.结论 桡动脉扩展了全动脉化冠状动脉旁路移植术的适用范围.精细的桡动脉获取技术与合理选择靶血管是确保桡动脉良好远期通畅率的重要条件.%Objective Reviewed the experience of 12-years' application of the radial artery conduits to the coronary revascularization was retrospectively with emphasis on surgical harvesting techniques and perioperative management.Methods From June 2001 to June 2013,118 radial artery conduits were harvested in 87 males and 6 females,aged 28 to 66(mean 49.9) years.Coronary angiogram demonstrated isolated left main stenosis in 2 patients,concomitant left main lesions in 39,2-vessel disease in 2,and 3-vessel disease in 89.Preoperative heart function (NYHA) were:3 cases in Class Ⅰ,39 in Ⅱ,and 51 in Class Ⅲ.To offset and overcome the inadequacy of the traditional preoperative Allen' s test,an ‘ Intra-operative Allen’ s Test' was innovated and applied to the harvesting procedure to safeguard blood supply to the arm and hand.To further prevent the diathermy' s thermal injury to the radial artery,the ‘ Double-clip & scissors-cut' technique was initiated and carried out on every case.Results On-pump coronary artery bypass was performed in 92 cases and off-pump in 1.There was 1 operative death (1.1％) and 2 postoperative myocardial infarctions.The internal mammary artery and great saphenous veins were also used as conduits in addition to the radial arteries.One hundred and twenty-two out of the total 272 distal anastomoses (44.9％) were constructed with radial arteries.Average number of grafts was 2.9 per patient (range,2-6).Left radial artery was harvested in 67 patients,right in 1,and bilateral radial arteries in 25.No major ischaemic or functional complications occurred in the arm or hand.Postoperative follow-up at 3-139 (mean,59) months were eligible on 90 cases.Eighty-three patients had no further cardiac ischemic symptoms,while the remaining 7 cases had minimal angina.Heart function had generally improved,with 28 patients in NYHA Class Ⅰ,61 in Class Ⅱ,and the remaining 1 in Class Ⅲ.Postoperative angiogram and/or multi slice CT scan were performed on 85 cases with a total of 102 radial arteries.String sign occurred in 1 patient in whom the radial artery was connected to a big right coronary artery with a stenosis around 60％.Two radial arteries in 2 patients were found occluded,and 4 radial artery conduits in 3 other patients demonstrated stenosis or luminal irregularity.No significant lesions were present in the remaining 85 patients,yielding a 93.1％ patency rate of the radial artery conduit in this group.Conclusion While the internal mammary artery remains the gold standard for coronary revascularization,the radial artery is an excellent conduit that broadens the options for total arterial coronary artery bypass grafting surgery.Good long term patency of this conduit could be achieved through careful harvesting techniques and choose of proper target coronary vessels including size and degree of stenosis.The Double-clip and Scissors-cut maneuver minimizes the possible thermal injury from the diathermy to the radial artery grafts.This practice may contribute to the long-term patency in addition to the No-touch technique.
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