Clinical Study of Long-term Patency Rate of Great Saphenous Veins Transplanted by Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIANSong-yi , LINFan , WANGFei , YEZhi-dong , YANGYu-guang , SUNGuang , LIUPeng ,  WANGFeng-lin

Department of Cardiacvascular Surgery, China-Japan Friendship Hospital, Beijing 100029, P. R. China;

Corresponding author：

WANGFeng-lin, Email: wfl921@163.com

Keywords：

Coronary artery bypass grafting; Complete revascularization on cardiopulmonary bypass; Great saphenous venous sequential aortic coronary artery bypass grafting; Saphenous vein graft long-term patency

DOI：

10.7507/1007-4848.20160193

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Objective To summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting. Method We retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube 6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge. Result Four patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina. Conclusion carefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.

Citation： QIANSong-yi, LINFan, WANGFei, YEZhi-dong, YANGYu-guang, SUNGuang, LIUPeng, WANGFeng-lin. Clinical Study of Long-term Patency Rate of Great Saphenous Veins Transplanted by Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 804-809. doi: 10.7507/1007-4848.20160193 Copy

1.	曹德生, 王凤林, 刘鹏.大隐静脉序贯式完全性血运重建远期随访.中国心血管病研究, 2007, 5(12):893-895.
2.	王凤林.冠状动脉旁路移植后5年静脉桥全部通畅.中华胸心血管外科杂志, 2005, 21(5):288.
3.	Shuhaiber JH, Evans AN, Massad MG, et al. Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothoracic Surg, 2002, 22(3):387-396.
4.	Efthymiou CA, Weir WI, Timmis AD. Saphenous vein graft patency:33 year angiographic finding of a pristine vein graft to the left anterior descending artery. Heart, 2013, 99(9):674.
5.	刘畅, 刘宗泓, 肖喜刚, 等.体外与非体外循环冠状动脉旁路移植术后移植血管通畅率的比较.中国胸心血管外科临床杂志, 2013, 20(3):289-293.
6.	Zhao DX, Leacche M, Balaguer JM, et al. Routine intraoperative completion angiography after coronary bypass grafting and 1-stop hybrid revascularization. JACC, 2009, 53(3):232-241.
7.	Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery-Insight from prevent Ⅳ. Circu-lation, 2014, 130(17):1445-1451.
8.	Wijnberg DS, Boeve WJ, Ebels T, et al. Patency of arm vein grafts used in aorta-coronary bypass surgery. Eur J Cardiothorac Surg, 1990, 4(9):510-513.
9.	Goldman S, Copeland J, Moitz T, et al. Starting asprin therapy after operation:Effect on early graft patency. Department Veterans affairs Cooperative Study Group. Circulation, 1991, 84(2):520-526.
10.	Poston RS, Kwon MH, Gu J. Role of procurement-related injury in early saphenous vein graft failure after coronary artery bypass surgery. Future Cardiol, 2006, 2(4):503-512.
11.	Neitzel GF, Barboriak JJ, Pintar K, et al. Atherosclerosis in aortoco-ronary bypass grafts:Mophology study and risk factor analysis 6 to 12 years after surgery. Atherosclerosis, 1986, 6(6):594-600.
12.	Christenson JT, Schmuziger M. Sequential venous bypass grafts:Result 10 years later. Ann Thorac Surg, 1997, 67(2):371-376.
13.	Grow lB, Brantigan CO. The diamond anastomosis:A technique, for creating a right-angle side-to-side vasculac anastomosis. J Thorac Cardiovasc Surg, 1975, 69(2):188-189.
14.	Niinami H, Takech Yi. Coronary artery bypass grafting using side-to-side anastomosis. Japan J Thorac Surg, 2000, 53(9):747-749.
15.	Sottiurai VS. Distal anastomotic intimal hyperplasia:histocy tomorphology, pathophysiology, etiology, and prevention. Int J Angiol, 1999, 8(1):1-10.
16.	王凤林, 主编.冠状动脉移植外科-安全措施及错误防范:各种吻合口的吻合技术.北京:北京大学出版社, 2010. 104-147.
17.	Bond MG, Hostetler JR, Karayannacos PE, et al. Intimal changes in arteriovenous bypass graft:Effect of varying the angle of implanta-tion at proximal anastomosis and producing stenosis in the distal run off artery. J Thorac Cardiovasc Surg, 1976, 71(6):907-916.
18.	Leask RL, Jagdish B, Johnston KW, et al. Human saphenous vein coronary artery bypass graft morphology, geometry and hemodyna-mics. Ann Bio Eng, 2005, 33(3):301-309.
19.	Griffith LS, Bulkley BN, Hutchins GM, et al. Occlusive changes at coronary-bypass graft anastomosis. J Thorac Cardiovasc Surg, 1977, 73(5):668-679.
20.	Hutchins GM, Bulkley BH. Mechanisms of occlusion of saphenous vein-coronary artery "jump" grafts. J Thorac Cardiovasc Surg, 1977, 73(5):660-667.
21.	Tiwari A, Cheng, KS, Salacinski H, et al. Improving the patency of vascular bypass grafts:the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch. Eur J Endovasc Surg, 2003, 25(4):287-295.
22.	Tozzi P, Hayoz D, Ruchat P, et al. Animal model to compare the effects of suture technique n cross section complaiance on end-to-side anastomoses. Eur J Cardiothorac Surg, 2001, 19(4):477-481.

1. 曹德生, 王凤林, 刘鹏.大隐静脉序贯式完全性血运重建远期随访.中国心血管病研究, 2007, 5(12):893-895.
2. 王凤林.冠状动脉旁路移植后5年静脉桥全部通畅.中华胸心血管外科杂志, 2005, 21(5):288.
3. Shuhaiber JH, Evans AN, Massad MG, et al. Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothoracic Surg, 2002, 22(3):387-396.
4. Efthymiou CA, Weir WI, Timmis AD. Saphenous vein graft patency:33 year angiographic finding of a pristine vein graft to the left anterior descending artery. Heart, 2013, 99(9):674.
5. 刘畅, 刘宗泓, 肖喜刚, 等.体外与非体外循环冠状动脉旁路移植术后移植血管通畅率的比较.中国胸心血管外科临床杂志, 2013, 20(3):289-293.
6. Zhao DX, Leacche M, Balaguer JM, et al. Routine intraoperative completion angiography after coronary bypass grafting and 1-stop hybrid revascularization. JACC, 2009, 53(3):232-241.
7. Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery-Insight from prevent Ⅳ. Circu-lation, 2014, 130(17):1445-1451.
8. Wijnberg DS, Boeve WJ, Ebels T, et al. Patency of arm vein grafts used in aorta-coronary bypass surgery. Eur J Cardiothorac Surg, 1990, 4(9):510-513.
9. Goldman S, Copeland J, Moitz T, et al. Starting asprin therapy after operation:Effect on early graft patency. Department Veterans affairs Cooperative Study Group. Circulation, 1991, 84(2):520-526.
10. Poston RS, Kwon MH, Gu J. Role of procurement-related injury in early saphenous vein graft failure after coronary artery bypass surgery. Future Cardiol, 2006, 2(4):503-512.
11. Neitzel GF, Barboriak JJ, Pintar K, et al. Atherosclerosis in aortoco-ronary bypass grafts:Mophology study and risk factor analysis 6 to 12 years after surgery. Atherosclerosis, 1986, 6(6):594-600.
12. Christenson JT, Schmuziger M. Sequential venous bypass grafts:Result 10 years later. Ann Thorac Surg, 1997, 67(2):371-376.
13. Grow lB, Brantigan CO. The diamond anastomosis:A technique, for creating a right-angle side-to-side vasculac anastomosis. J Thorac Cardiovasc Surg, 1975, 69(2):188-189.
14. Niinami H, Takech Yi. Coronary artery bypass grafting using side-to-side anastomosis. Japan J Thorac Surg, 2000, 53(9):747-749.
15. Sottiurai VS. Distal anastomotic intimal hyperplasia:histocy tomorphology, pathophysiology, etiology, and prevention. Int J Angiol, 1999, 8(1):1-10.
16. 王凤林, 主编.冠状动脉移植外科-安全措施及错误防范:各种吻合口的吻合技术.北京:北京大学出版社, 2010. 104-147.
17. Bond MG, Hostetler JR, Karayannacos PE, et al. Intimal changes in arteriovenous bypass graft:Effect of varying the angle of implanta-tion at proximal anastomosis and producing stenosis in the distal run off artery. J Thorac Cardiovasc Surg, 1976, 71(6):907-916.
18. Leask RL, Jagdish B, Johnston KW, et al. Human saphenous vein coronary artery bypass graft morphology, geometry and hemodyna-mics. Ann Bio Eng, 2005, 33(3):301-309.
19. Griffith LS, Bulkley BN, Hutchins GM, et al. Occlusive changes at coronary-bypass graft anastomosis. J Thorac Cardiovasc Surg, 1977, 73(5):668-679.
20. Hutchins GM, Bulkley BH. Mechanisms of occlusion of saphenous vein-coronary artery "jump" grafts. J Thorac Cardiovasc Surg, 1977, 73(5):660-667.
21. Tiwari A, Cheng, KS, Salacinski H, et al. Improving the patency of vascular bypass grafts:the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch. Eur J Endovasc Surg, 2003, 25(4):287-295.
22. Tozzi P, Hayoz D, Ruchat P, et al. Animal model to compare the effects of suture technique n cross section complaiance on end-to-side anastomoses. Eur J Cardiothorac Surg, 2001, 19(4):477-481.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Study of Long-term Patency Rate of Great Saphenous Veins Transplanted by Coronary Artery Bypass Grafting

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