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目的分析冠状动脉(冠脉)旁路移植术(CABG)后再发心绞痛的原因及进行介入治疗的有效性和安全性。方法再发缺血症状的 CABG 术后老年患者78例.进行冠脉和桥血管造影,并同时对53例进行介入治疗。结果 78例均进行冠脉和桥血管造影,其中8例桥血管通畅,原冠脉病变无或有轻微发展;17例桥血管严重狭窄或全部闭塞,同时,原冠脉3支弥漫严重病变;53例原冠脉血管病变有明显进展或桥血管出现严重病变或闭塞。78例共移植桥血管226支(其中大隐静脉桥血管153支,乳内动脉桥69支,桡动脉桥4支)。大隐静脉桥血管1 53支中,110支发生病变(71.9%,其中长段弥漫性病变或完全闭塞77支,吻合口狭窄14支,体部狭窄1 9支)。乳内动脉桥共69支,27支发生病变,占39.1%(其中全程弥漫性病变和完全闭塞12支,吻合口狭窄15支)。桡动脉桥共4支,通畅3支,吻合口狭窄1支。226支桥血管发生病变共有138支(包括大隐静脉桥血管110支,乳内动脉桥27支,桡动脉桥1支),桥血管吻合口狭窄30支,体部病变19支,弥漫病变或完全闭塞89支。在吻合口狭窄的桥血管中,术后0～3个月发生21支(70.0%),术后3～12个月发生9支(30.0%),术后1年以上无吻合口狭窄。在体部病变的桥血管中术后0～3个月未发生病变,术后3～12个月发生10支(52.6%),术后1年以上发生9支(47.7%)。桥血管弥漫病变或完全闭塞术后0～3个月发生28支(31.5%),术后3～12个月发生14支(15.7%),术后1年以上发生47支(52.8%)。53例患者进行原发血管和(或)桥血管介入治疗,50例介入治疗成功(94.3%)。所有病变介入治疗后均即刻获得良好结果,30d随访,未出现严重心脏事件。结论 CABG 术后再发心绞痛介入治疗成功率、有效性、安全性均较高,介入治疗可作为 CABG 术后再发缺血的主要治疗手段之一。
Objective To analyze the causes of angina pectoris after coronary artery bypass grafting (CABG) and the effectiveness and safety of interventional therapy. Methods Seventy-eight elderly patients undergoing CABG with ischemic symptoms were enrolled in this study, and coronary angiography and coronary angiography were performed. At the same time, 53 patients underwent interventional therapy. Results All of the 78 cases underwent coronary angiography and coronary angiography. Among them, 8 cases had unobstructed bridging vessels with no or slight development of primary coronary artery disease. Severe stenosis or occlusion of 17 cases with severe vascular occlusion was observed. At the same time, 53 cases of the original coronary artery disease has significant progress or serious vascular bridging lesions or occlusion. There were 226 vascular grafts in 78 patients (including 153 saphenous vein grafts, 69 internal mammary artery grafts, and 4 radial artery grafts). Of the 153 saphenous vein grafts, 110 had lesions (71.9%), of which 79 were diffuse lesions or complete occlusion, 14 were anastomotic stenoses, and 19 were stenosed. A total of 69 internal mammary artery bridges, 27 lesions occurred, accounting for 39.1% (of which diffuse lesions and complete occlusion of 12, anastomotic stenosis 15). A total of 4 radial artery bridge, smooth 3, anastomotic stenosis 1. A total of 138 angiographic lesions (including 110 saphenous vein vessels, 27 internal mammary artery grafts and 1 radial artery bridge), 30 vascular anastomosis stenoses, 19 body lesions, diffuse lesions or Completely blocked 89. There were 21 (70.0%) cases in 0-3 months postoperatively and 9 (30.0%) cases in 3-12 months postoperatively. There was no anastomotic stenosis more than 1 year after operation. No lesions were observed 0 to 3 months postoperatively in the bridge vessels of the diseased body, 10 (52.6%) occurred 3-12 months after operation, and 9 (47.7%) occurred more than 1 year after operation. There were 28 (31.5%) cases at 0 ~ 3 months after the diffuse or complete occlusion of the bridge, 14 (15.7%) at 3-12 months after operation and 47 (52.8%) at more than 1 year after operation. Fifty-three patients underwent primary vascular and (or) bridging vascular intervention, with 50 interventions successfully (94.3%). Good results were obtained immediately after the interventional treatment of all lesions. No serious cardiac events occurred after 30 days of follow-up. Conclusion The successful rate, effective and safety of recurrent angina pectoris after CABG surgery are high. Interventional therapy can be used as one of the main treatments for recurrent ischemia after CABG.