Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Analysis of Postoperative Coronary Angiography in Symptomatic Patients

관상동맥 우회술 시행 후 증상이 있는 환자에서 시행한 관상동맥 조영술의 분석

  • Kim Young-Hak (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Han San-Woong (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Kang Jeong-Ho (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Kim Hyuck (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Lee Chul-Burm (Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, College of Medicine, Hanyang University) ;
  • Chon Soon-Ho (Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, College of Medicine, Hanyang University) ;
  • Nam Seung-Hyuk (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Chung Won-Sang (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University)
  • 김영학 (한양대학교 의과대학 서울병원 흉부외과) ;
  • 한산웅 (한양대학교 의과대학 서울병원 흉부외과) ;
  • 강정호 (한양대학교 의과대학 서울병원 흉부외과) ;
  • 김혁 (한양대학교 의과대학 서울병원 흉부외과) ;
  • 이철범 (한양대학교 의과대학 구리병원 흉부외과) ;
  • 전순호 (한양대학교 의과대학 구리병원 흉부외과) ;
  • 남승혁 (한양대학교 의과대학 서울병원 흉부외과) ;
  • 정원상 (한양대학교 의과대학 서울병원 흉부외과)
  • Published : 2006.10.01
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Abstract

Background: We analyzed post-operative angiography performed in symptomatic patients to evaluate the patency rates and the roles of grafts. Material and Method: We reviewed 52 (15%) coronary angiograms performed for recurrent angina after prior coronary artery bypass surgery from January 1995 to June 2005. A total of 345 patients underwent coronary artery bypass surgery during this period. There were 41 men and 11 women and the mean age was $64.07{\pm}15.58$ years. The median period from operation to re-angiogram was 68.5 months (range, 1 to 126 months). The numbers of grafts and peripheral anastomoses were 42 and 43 for internal thoracic artery (ITA), 14 and 20 for radial artery (RA), and 49 and 89 for saphenous vein. The mean number of anastomosis was 2.9 per patient, Result: The patency rates of ITA, RA and saphenous vein graft (SVG) were 37/43 (86%), 17/20 (85%) and 34/89 (38.2%). The patency rate of arterial grafts was significantly higher than that of SVG (p< 0.001) and the patency rate of the RA was comparable to that of ITA (p=0.942). The patency rate of sequential SVGs was higher than that of single SVG (40.3% vs 31.8%, p=0.478) and the patency rate of proximal segments in sequential anastomosis was higher than that in single anastomsis (55.6% vs 31.8%, p=0.097), but statistically not significant. Conclusion: Arterial grafts have markedly superior patency rates than SVGs, so consideration should be given to the vigorous use of arterial grafts. The patency rate of the RA was comparable to that of ITA.

배경: 관상동맥 우회술 후 증상이 있는 환자에서 시행한 관상동맥 조영술 소견을 분석함으로써 사용된 이식 혈관들의 개존율과 도관으로서의 유용성을 알아보고자 하였다. 대상 및 방법: 1995년 1월부터 2005년 6월까지 관상동맥 우회술을 시행 받은 총 345명의 환자 중 흉통을 호소하여 관상동맥 조영술을 시행한 52명(15%)을 대상으로 하였다. 성별은 남자 41명, 여자 11명이었고 평균 연령은 $64.07{\pm}15.58$세 였다. 수술에서 관상동맥 조영술까지의 기간은 중앙값 68.5개월($1{\sim}126$개월)이었다. 사용된 도관과 문합수는 내흉동맥 42개로 43개소 문합, 요골동맥은 14개로 20개소 문합, 복재정 맥은 49개로 89개소를 문합하여 환자 1명당 평균 2.9개의 문합이 시행되었다. 결과: 내흉동맥, 요골동맥, 복재정맥의 개존율은 각각 86% (37/43), 85% (17/20), 38.2% (34/89)였다. 동맥 도관의 개존율은 복재정맥의 개존율보다 의미 있게 높았고(p<0.001), 요골동맥의 개존율은 내흉동맥과 차이가 없었다(p=0.912). 복재정맥에서 다중 문합의 경우 단일 문합에서보다 개존율이 높았고(40.3% vs 31.8%, p=0.478), 다중 문합을 시행한 경우 근위부 분절(대동맥과 첫 번째 원위부 문합 사이)의 개존율은 55.6%로 단일 문합에서의 개존율 31.8%보다 높았으나 통계적 의의는 없었다(p=0.097). 결론: 술 후 증상이 있는 환자에서 시행한 관상동맥 조영술에서 동맥 도관은 복재정맥보다 높은 개존율을 나타내어 동맥 도관의 적극적인 사용이 필요할 것으로 생각된다. 요골동맥의 개존율은 내흉동맥과 차이가 없었다.

Keywords

References

  1. Shah PJ, Bui K, Blackmore S, et al. Has the in right internal thoracic artery been overlooked? An angiographicstudy of the radial artery, internal thoracic arteries and saphenous vein graft patencies in symptomatic patients. Eur J Cardiothorac Surg 2005;27:870-5 https://doi.org/10.1016/j.ejcts.2005.01.027
  2. Kim KB, Kim H, Sung KI. One-year graft patency after coronary artery bypass surgery. Korean J Thorac Cardiovasc Surg 1997;30:1190-6
  3. Ryu KM, Kim SH, Park SS, et al. Early result of the coronary artery bypass surgery. Korean Thorac Cardiovasc Surg 2000;33:487-93
  4. Kolessov VI. Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris. J Thorac Cardiovasc Surg 1967;54:535-44
  5. Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease: operative technique. J Thorac Cardiovasc Surg 1969;58:178-85
  6. Royse AG, Royse CF, Tatoulis J, et al. Postoperative radial artery angiography for coronary artery bypass surgery. Eur J Cardiothorac Surg 2000;17:294-304 https://doi.org/10.1016/S1010-7940(99)00364-4
  7. Acar C, Ramsheyi A, Pagny JY, et al. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 1998;116: 981-9 https://doi.org/10.1016/S0022-5223(98)70050-9
  8. Maniar HS, Sundt TM, Barner HB, et al. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovas Surg 2002;123:45-52 https://doi.org/10.1067/mtc.2002.118686
  9. Moran SV, Baeza R, Guarda E, et al. Predictors of radial artery patency for coronary bypass operations. Ann Thorac Surg 2001;72:1552-6 https://doi.org/10.1016/S0003-4975(01)03090-9
  10. Khot UN, Friedman DT, Pettersson G, et al. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts. Circulation 2004;109:2086-91 https://doi.org/10.1161/01.CIR.0000127570.20508.5C
  11. Fitzgibbon GM. Coronary bypass graft failure: long-term angiographic study. J Am Coll Cardiol 1991;17:1075-80 https://doi.org/10.1016/0735-1097(91)90834-V
  12. Fitzgibbon GM. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 1996;28:616-26 https://doi.org/10.1016/0735-1097(96)00108-8
  13. Campeau L, Enjalbert M, Lesperance J, et al. Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks, 1 year, 5 to 7 years, and 10 to 12 years after surgery. Circulation 1983;68;1-7
  14. Grondin CM, Campeau L, Lesperance J, et al. Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation 1984;70:208-12
  15. Cataldo G, Braga M, Pirotta N, et al. Factors influencing 1- year patency of coronary artery saphenous vein grafts. Circulation 1993;88:93-8
  16. Vural KM, Sener E, Tasdemir O. Long-term patency of sequential and individual saphenous vein coronary bypass grafts. Eur J Cardiothorac Surg 2001;19:140-4 https://doi.org/10.1016/S1010-7940(00)00629-1
  17. Rittger SE, Karayannacos PE, Guy JF, et al. Velocity distribution and intimal proliferation in autologous vein grafts indogs. Circ Res 1978;42:792-801 https://doi.org/10.1161/01.RES.42.6.792
  18. Lawrie GM, Morris GC, Chapman DW, et al. Patterns of patency of 596 vein grafts up to seven years aorta-coronary bypass. J Thorac Cardiovasc Surg 1977;73:443