2020 年第 7 期 第 15 卷

静脉桥血管病变介入治疗的相关进展

Research progress of interventional therapy for saphenous venous grafts

作者：董劭壮杨清

英文作者：Dong Shaozhuang Yang Qing

单位：天津医科大学总医院心血管内科300052

英文单位：Department of Cardiovascular Medicine General Hospital of Tianjin Medical University Tianjin 300052 China

关键词：静脉桥血管；冠状动脉旁路移植术；经皮冠状动脉介入；血栓保护装置

英文关键词：Saphenousvenousgrafts；Coronaryarterybypassgrafting；Percutaneouscoronaryintervention；Emboliprotectiondevice

• 摘要：

• 冠状动脉旁路移植术（CABG）后静脉桥血管（SVG）病变的处理是经皮冠状动脉介入（PCI）治疗的难点。治疗方案要综合考虑SVG病变和原位冠状动脉病变的特点、合并疾病和药物治疗等方面。要慎重选择需行手术干预的患者、手术方式、PCI的靶血管和支架类型。指南建议，CABG术后再发心血管事件，对于药物治疗无效，或有大面积心肌缺血的客观证据时，适于再次血运重建治疗。血运重建尽量首先尝试PCI。如果技术可行，应优先选择处理原位冠状动脉。与金属裸支架相比，药物洗脱支架可能有短期获益，如果没有长期抗血小板治疗的禁忌证，PCI应使用药物支架。SVG体部病变适于使用血栓保护装置来降低远端栓塞和无复流风险。

• The treatment of the failed saphenous venous grafts (SVG) after coronary artery bypass grafting (CABG) is a big challenge for percutaneous coronary intervention (PCI). The strategy should include various aspects such as the plaques characteristics of grafts and in-situ coronary arteries, complicating diseases and the medical regimens. The choice should be carefully made and include the appropriate patients, revascularization, target vessels and stent types. In the recurrence of cardiovascular events after CABG, revascularization may be effective. PCI of in-situ coronaries is preferred. Drug-eluting stents may have short-term benefits comparing with bare metal stents. Emboli protection device is suitable for the lesions in SVG body to reduce the risk of distal embolization without reflow.