RESUMEN
OBJECTIVE: Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting.Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. METHODS: Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. RESULTS: The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). CONCLUSION: Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization.
Asunto(s)
Anastomosis Quirúrgica , Puente de Arteria Coronaria , Oclusión de Injerto Vascular , Vena Safena , Grado de Desobstrucción Vascular , Humanos , Vena Safena/trasplante , Vena Safena/diagnóstico por imagen , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Estudios de Seguimiento , Angiografía Coronaria , Angiografía por Tomografía ComputarizadaRESUMEN
BACKGROUND Traumatic thoracic aortic transection is one of the most severe complications of high-energy injuries, but patients rarely receive treatment, and it is fatal in the vast majority of cases. Due to the complexity of surgical revision for transection, endovascular repair with stent graft implantation is the preferred approach. MATERIAL AND METHODS We retrospectively analyzed the short-term and long-term treatment results for 31 patients (29 men, 2 women) treated at the Interventional Radiology Department, University Hospital Ostrava, for the isthmus part of a descending thoracic aorta injury between 2004 and 2020. RESULTS The median patient age was 48 years (interquartile range [IQR]: 28-63 years). The most common causes of injury were traffic accidents and falls or jumps, with the trauma location at the Ishimaru zones 2 to 4 of the aortic isthmus. Aortic stent grafts were successfully implanted in all patients; 13% of patients had complications and 10% died due to the trauma severity. The median procedure duration was 30 min (IQR: 25-43 min) and the median hospital stay was 29 days (IQR: 28-63 days). CONCLUSIONS Aortic stent graft implantation appears to be a safe and effective method for dealing with thoracic aorta injury, with a low complication rate and high patient survival. The endovascular approach is the method of choice for treating this severe disease, and a multidisciplinary approach for emergency medical treatment with a comprehensive trauma protocol is essential.
Asunto(s)
Aorta Torácica/lesiones , Aorta Torácica/cirugía , Procedimientos Endovasculares/métodos , Traumatismos Torácicos/cirugía , Adulto , República Checa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIMS: The aim of this study was to compare coronary artery bypass grafting (CABG) using either endoscopic (EVH) or open harvest (OVH). Leg-related morbidity and histological comparison of the veins were the outcome measures. METHODS: One hundred consecutive patients scheduled for isolated CABG were randomly divided into two goups: an EVH and OVH group. Perioperative data were recorded. Patients were examined 7 days and 1 month postoperatively for leg-related morbidity. Samples for histological examination were taken from each harvested vein during the surgery. RESULTS: Postoperative pain was statistically significantly lower in the EVH group 7 days postoperatively but the incidence of haematoma was non statistically higher in the EVH group while swelling was higher in the OVH group. Almost 40% of all histological samples were described as showing endothelial damage. There was significantly more endothelial damage in the EVH than the OVH group. CONCLUSIONS: We confirmed the advantage of EVH in terms of leg-related morbidity as well as cosmetic effect. This method however, was associated with more acute endothelial damage of the graft. These results support concerns that endoscopic vein harvest may be connected with detrimental effects on vein endothelium which could promote a thrombogenic environment leading to a decrease in graft patency. This could be extremely important. The results suggest that further investigation of the long-term patency of vein grafts harvested endoscopically is required.