internal thoracic artery

胸廓内动脉
  • 文章类型: Journal Article
    缺血性心脏病是美国死亡的主要原因。根据冠状动脉疾病的严重程度,治疗方案包括经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG).尽管CABG自1970年代以来一直在进行,关于左胸内动脉后使用哪种导管仍存在争议。目前,国家登记处报告左胸廓内动脉和隐静脉是CABG中最常用的导管,而其他动脉移植物,比如桡动脉,代表少数,尽管目前的证据表明这些动脉导管的潜在益处。在这次审查中,我们旨在描述用于CABG的不同类型的动脉导管,并总结其使用背后的证据.
    Ischemic heart disease is the leading cause of death in the United States. Depending on the severity of the coronary artery disease, treatment options include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Although CABG has been performed since the 1970s, there is still debate onwhich conduit to use after the left internal thoracic artery. Currently, national registries report the left internal thoracic artery and the saphenous vein as the most commonly used conduits in CABG, while other arterial grafts, such as the radial artery, represent a minority, even though the current evidence suggests potential benefits of these arterial conduits. In this review, we aimed to describe the different types of arterial conduits used for CABG and summarize the evidence behind their use.
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  • 文章类型: Journal Article
    在冠状动脉搭桥手术中利用胸廓内动脉(ITA)的益处是众所周知的。然而,这种做法在老年患者中的安全性需要得到证明。
    我们研究了所有75岁及以上的患者,在接受隔离治疗时至少接受过一次ITA移植,2002年1月1日至2020年12月31日(19年)常规(正中胸骨切开术)冠状动脉旁路移植术(CABG)。紧急手术被排除在外。倾向评分匹配用于降低患者选择效果。研究结果是30天死亡率,两组相关的术中参数和术后参数。
    共纳入1855名接受CABG的患者,其中1114接受了单个左(s)ITA,741接受了左(d)ITA移植物。519对匹配。sITA或dITA的决定是单独做出的。两组的30天死亡率均较低,且相似(sITA3.3%;dITA2.9%,p=0.859)。dITA后胸骨伤口愈合障碍的发生率更高(3.3vs6.9%;p<0.011),皮肤对皮肤的手术时间也更长(181对205分钟;p<0.0001)。再次开胸率相似(4.6vs6.2%;p=0.340)。其他次要参数没有显着差异。
    在老年患者中采集两种ITA是安全可行的。然而,它增加了胸骨伤口愈合障碍的风险。长期利益仍有待证明。
    UNASSIGNED: The benefits of utilizing internal thoracic arteries (ITAs) in coronary bypass surgery are well-known. However, the safety of this practice in elderly patients needs to be proven.
    UNASSIGNED: We studied all patients who are 75 years of age and older, who received at least one ITA graft while undergoing isolated, conventional (median sternotomy) coronary artery bypass graft surgery (CABG) between Jan 1st 2002 and Dec 31st 2020 (19 years). Emergent surgeries were excluded. Propensity score matching was used to reduce the patient selection effect. Study outcomes were 30-days mortality, and two sets of dependent intraoperative parameters and postoperative parameters.
    UNASSIGNED: A total of 1855 patients undergoing CABG was included, of which 1114 received a single left (s)ITA and 741 received combined left and right (d)ITA grafts. 519 pairs were matched. The decision for sITA or dITA was made individually. Thirty-days mortality was low and similar in both groups (sITA 3.3%; dITA 2.9%, p = 0.859). The incidence of sternal wound healing disorder was higher after dITA (3.3 vs 6.9%; p < 0.011), which had also a longer skin-to-skin operative time (181 vs 205 min; p < 0.0001). Re-thoracotomy rates were similar (4.6 vs 6.2%; p = 0.340). There were no significant differences in other secondary parameters.
    UNASSIGNED: harvesting both ITAs in elderly patients is safe and feasible. However, it increases the risk of sternal wound healing disorders. Long term benefit still needs to be proven.
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  • 文章类型: Journal Article
    背景:胸廓内动脉(ITA)是冠状动脉旁路移植术最重要的导管。最近的证据表明,骨骼化的ITA收获产生的长期结果不如带蒂收获。目的是调查ITA收获方法对10年死亡率和主要不良心血管事件的影响。
    结果:在这项观察性队列研究中,我们从SWEDEHEART(根据推荐的治疗方法评估的增强和发展心脏病循证护理的瑞典网络系统)登记中确定了所有患者,这些患者在2012年至2021年期间在卡罗林斯卡大学医院接受了至少1次ITA的单独冠状动脉旁路移植术.主要结果是全因死亡率,次要结果是心肌梗死的组合,重复血运重建,心力衰竭,和中风。使用国家健康数据寄存器确定结果,并使用加权灵活参数生存模型在骨骼化和带蒂组之间进行比较。在3267名患者中,1657(51%)进行了带蒂的ITA收获,1610(49%)进行了骨骼化的ITA收获。病人的平均年龄是66岁,15%是女性。带蒂与骨骼化ITA组的加权全因死亡率发生率分别为2.6%(95CI,2.2%-3.0%)和2.6%(95%CI,2.2%-3.1%),分别(危险比(HR),1.01[95%CI,0.81-1.27])。加权主要不良心血管事件发生率分别为7.8%(95%CI,7.1%-8.6%)和7.5%(95%CI,6.7%-8.4%),分别(HR,0.94[95%CI,0.82-1.08])。
    结论:我们发现两种ITA采集方法在全因死亡率或主要不良心血管事件发生率方面没有显著差异。
    BACKGROUND: The internal thoracic artery (ITA) is the most important conduit for coronary artery bypass grafting. Recent evidence suggests that skeletonized ITA harvesting yields long-term outcomes inferior to those of pedicled harvesting. The aim was to investigate the impact of the ITA harvesting method on 10-year mortality and major adverse cardiovascular events.
    RESULTS: In this observational cohort study, we identified all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent isolated coronary artery bypass grafting using at least 1 ITA at Karolinska University Hospital from 2012 to 2021. The main outcome was all-cause mortality, and the secondary outcomes were a combination of myocardial infarction, repeat revascularization, heart failure, and stroke. Outcomes were ascertained using national health data registers and compared between the skeletonized and pedicled groups using weighted flexible parametric survival models. Among 3267 patients, 1657 (51%) underwent pedicled ITA harvesting and 1610 (49%) underwent skeletonized ITA harvesting. The patients\' mean age was 66 years, and 15% were women. The weighted all-cause mortality incidence rate in the pedicled versus skeletonized ITA group was 2.6% (95CI, 2.2%-3.0%) versus 2.6% (95% CI, 2.2%-3.1%), respectively (hazard ratio (HR), 1.01 [95% CI, 0.81-1.27]). The weighted major adverse cardiovascular events incidence rate was 7.8% (95% CI, 7.1%-8.6%) versus 7.5% (95% CI, 6.7%-8.4%), respectively (HR, 0.94 [95% CI, 0.82-1.08]).
    CONCLUSIONS: We found no significant differences in all-cause mortality or major adverse cardiovascular events rates between the 2 ITA harvesting methods.
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
    假性动脉瘤,或者假性动脉瘤,是由动脉壁破裂引起的临床实体,导致血液泄漏,这是由sorroundig组织限制。大量血胸构成了一种危及生命的疾病,需要及时和准确的医疗反应。
    产褥期因左胸内动脉假性动脉瘤出血,经外伤性剖宫产后出现大量血胸。最初的治疗包括胸骨切开术,然后通过血管栓塞进行决定性的治疗。
    精确评估,包括ITA假性动脉瘤的测量和定位对于制定适当的治疗策略至关重要。当前的医疗实践倾向于将血管内栓塞作为开放手术的可靠且微创的替代方案,将ir确立为选择的治疗方法。
    UNASSIGNED: Pseudoaneurysm, or false aneurysm, is a clinical entity caused by rupture of the arterial wall, leading to blood leakage that is confined by sorroundig tissue. Massive hemothorax constitutes a life-threatening condition demanding timely and accurate medical response.
    UNASSIGNED: A puerperal presented with a massive hemothorax precipitated by a traumatic cesarean section due to hemorrhage from a pseudoaneurysm of the left internal thoracic artery. Initial treatment involved a sternotomy, followed by a conclusive therapy via angioembolization.
    UNASSIGNED: Precise assessment, including the measurement and localization of the ITA pseudoaneurysm is crucial to formulate an appropriate therapeutic strategy. Current medial practice favors endovascular embolization as a reliable and minimally invasive alternative to open surgery, establishing ir as the treatment of choice.
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  • 文章类型: Journal Article
    目的:比较使用胸廓内动脉(ITA)或桡动脉(RA)作为第二动脉移植的左回旋支(LCx)血运重建的结果。
    方法:纳入使用ITA和使用另一个双侧ITA(BITA组)或RA(ITA-RA组)进行左前降支血运重建的原发性冠状动脉旁路移植术和LCx血运重建的患者。全因死亡率(主要终点),心脏死亡,主要不良心脏事件,在医院死亡,和深部胸骨伤口感染(次要终点)进行评估。
    结果:在790例患者中(BITA,n=548(69%);ITA-RA,n=242(31%)),在随访期间,两组之间的全因死亡率没有显着差异(风险比(HR):0.87;95%置信区间(CI):0.67-1.12;p=0.27)(平均值,10年)。多因素分析显示,BITA组的长期全因死亡率显著降低(HR:0.63;95%CI:0.48-0.84;p=0.01)。在倾向匹配队列中(n=480,240对),BITA组的全因死亡发生率明显较少(HR:0.66;95%CI0.47-0.93;p=0.02).次要结果没有显着差异。
    结论:当用作LCx血运重建的第二移植物时,在降低术后10年的全因死亡率方面,ITA移植物可能超过RA移植物。
    OBJECTIVE: To compare the outcomes of left circumflex artery (LCx) revascularization using an internal thoracic artery (ITA) or radial artery (RA) as the second arterial graft.
    METHODS: Patients who underwent primary isolated coronary artery bypass grafting with left anterior descending artery revascularization using an ITA and LCx revascularization using another bilateral ITA (BITA group) or an RA (ITA-RA group) were included. All-cause mortality (primary endpoint), cardiac death, major adverse cardiac events, in-hospital death, and deep sternal wound infection (secondary endpoints) were evaluated.
    RESULTS: Among 790 patients (BITA, n = 548 (69%); ITA-RA, n = 242 (31%)), no significant difference in all-cause mortality between the groups was observed (hazard ratio (HR): 0.87; 95% confidence interval (CI): 0.67-1.12; p = 0.27) during follow-up (mean, 10 years). Multivariate analysis revealed that the BITA group exhibited significantly lower rates of long-term all-cause mortality (HR: 0.63; 95% CI: 0.48-0.84; p = 0.01). In the propensity-matched cohort (n = 480, 240 pairs), significantly fewer all-cause deaths occurred in the BITA group (HR: 0.66; 95% CI 0.47-0.93; p = 0.02). There were no significant differences in secondary outcomes.
    CONCLUSIONS: When used as second grafts for LCx revascularization, ITA grafts may surpass RA grafts in reducing all-cause mortality 10 years postoperatively.
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  • 文章类型: Journal Article
    我们评估了通过左侧肋下切口用daVinciSP采集双侧胸内动脉的可行性。在两个人类尸体和两个活猪中,有足够长的导管进行多支血管移植的完全双侧动员是可能的。在所有模型中,创建肋下通道并对接SP系统需要14至21分钟,总收获时间为65至125分钟。在活猪中未观察到大出血,并且用可用的仪器进行止血。一头猪在手术过程中由于心室纤颤随后心脏骤停而死亡。外科医生在技术上很容易复制机器人收获,不需要额外的肋骨扩张。需要进一步的研究来评估这种使用达芬奇SP系统的肋下方法是否在患者中产生真正的临床益处。
    We evaluated the feasibility of harvesting bilateral internal thoracic arteries with the da Vinci Single Port system (SP) through a single left-sided subcostal incision. Complete bilateral mobilization with sufficiently long conduits for multivessel grafting was possible in 2 human cadavers and 2 live porcine. Creating the subcostal access and docking the SP system took between 14 and 21 min and the total harvest time ranged from 65 to 125 min in all models. No major bleeding was observed in the live porcine and hemostasis was managed with the available instrumentation. One porcine deceased during surgery due to ventricular fibrillation followed by cardiac arrest. The robotic harvesting was technically easily reproduced by the surgeons and required no additional rib-spreading. Further studies will be required to assess if this subcostal approach with the da Vinci SP system yields true clinical benefits in patients.
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  • 文章类型: Journal Article
    研究表明,由于其生长潜力,胸廓内动脉可作为分流选择。然而,缺乏长期数据。这里,1例单心室分流失败的患者胸廓内动脉增大.在将该动脉转换为Blalock-Taussig分流后,我们跟踪了患者12年,分析其增长以评估其有效性。
    Studies suggest the internal thoracic artery as a shunt option due to its growth potential. However, long-term data are lacking. Here, a patient with a failing single ventricle shunt had an enlarged internal thoracic artery. We followed the patient for 12 years after converting this artery into a Blalock-Taussig shunt, analysing its growth to assess its effectiveness.
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  • 文章类型: Journal Article
    目的:探讨心肺复苏过程中胸部按压相关性胸内动脉损伤(CAI)的发生率和模式,并确定用于治疗出血的栓塞技术。
    方法:对2013年5月至2019年12月在两个三级护理中心接受经导管动脉栓塞术(TAE)治疗由CAI引起的危及生命的出血的患者进行了回顾性研究。背景特征数据,影像学发现,从医疗记录中收集栓塞和结果.
    结果:在385例复苏后循环恢复的患者中,有9例(2.3%)需要TAE进行CAI。9名患者中有8名患有急性心肌梗死,并且在TAE之前都已经开始了体外膜氧合。七名患者有单侧,两例双侧胸廓内动脉损伤。27%可见胸廓内动脉主干损伤,而分支损伤占73%。六名患者(67%)在胸廓内动脉区域多处受伤,另有5人(56%)受伤。在所有情况下,我们使用2-氰基丙烯酸正丁酯和线圈(n=8)栓塞胸廓内动脉主干,只有明胶海绵(n=2),或线圈和明胶海绵(n=1)。TAE在技术上是成功的,没有任何并发症。30天死亡率为44%。
    结论:2.3%的患者在心肺复苏成功后发生了需要止血干预的CAI。分支损伤比主干损伤更常见,多发血管损伤很常见。TAE对于控制危及生命的出血似乎是安全有效的。
    OBJECTIVE: To investigate the incidence and patterns of chest compression-associated internal thoracic artery injury (CAI) during cardiopulmonary resuscitation and identify the embolization techniques used to treat hemorrhage.
    METHODS: A retrospective study was conducted in the patients who underwent transcatheter arterial embolization (TAE) for life-threatening hemorrhage caused by CAI at two tertiary care centers between May 2013 and December 2019. Data on background characteristics, imaging findings, embolization and outcomes were collected from the medical records.
    RESULTS: Among 385 patients in whom circulation returned after resuscitation, there were 9 patients (2.3%) who required TAE for CAI. Eight of 9 patients had acute myocardial infarction, and all had been started on extracorporeal membrane oxygenation before TAE. Seven patients had unilateral, and two had bilateral internal thoracic artery injuries. Main trunk injury of internal thoracic artery was seen in 27%, while branch injury in 73%. Six patients (67%) had multiple injuries in the internal thoracic artery territory, and five (56%) had injuries to other vessels. In all cases, we embolized the main trunk of the internal thoracic artery using n-butyl 2-cyanoacrylate and coils (n = 8), a gelatin sponge only (n = 2), or coils and a gelatin sponge (n = 1). TAE was technically successful in all, without any complication. The 30-day mortality rate was 44%.
    CONCLUSIONS: CAI needing hemostatic intervention occurred in 2.3% of patients after successful cardiopulmonary resuscitation. Branch injury was more common than main trunk injury, and multiple vessel injuries were common. TAE appears to be safe and effective for controlling life-threatening hemorrhage.
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  • 文章类型: Journal Article
    目的:本研究的目的是检查胸骨和隐静脉(SV)收获部位伤口并发症的发生率,并评估使用无接触(NT)SV减少冠状动脉旁路移植术后胸骨和腿部伤口并发症的策略。
    方法:纳入2021年3月至2023年6月(N=166)在新开放的心脏手术计划中,使用胸廓内动脉(ITA)和/或NTSV移植物进行冠状动脉旁路移植术(CABG)的患者。我们遵守了预防胸骨伤口感染的现行指南。此外,大多数患者使用单侧ITA,使用多根胸骨线(≥7根)和ZipFix精心闭合胸骨伤口.对于NTSV收获,LigaSure装置用于减少热损伤,伤口一丝不苟地闭合。
    结果:3/166(1.8%)患者出现胸骨伤口感染;所有3例患者均表现为胸骨浅表伤口感染。腿部伤口并发症出现在2/153(1.3%)患者中,在二次意向愈合后康复。
    结论:单侧使用ITA可将CABG术后胸骨伤口并发症降至最低,除了符合目前的指南外,精心闭合胸骨伤口。术前评估也可将NTSV收获后的伤口并发症降至最低。小心收割,细致的伤口闭合。
    OBJECTIVE: The aims of the present study were to examine sternal and saphenous vein (SV) harvest site wound complication rates, and to assess the strategies to minimize the sternal and leg wound complications after coronary artery bypass grafting using a no-touch (NT) SV.
    METHODS: Patients who underwent coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) and/or NT SV grafts from March 2021 to June 2023 (N = 166) at a newly opened cardiac surgical program were included. We obeyed the current guidelines for the prevention of sternal wound infection. In addition, unilateral ITA was used in most of the patients and the sternal wound was meticulously closed using multiple sternal wires (≥7) and ZipFix. For the NT SV harvesting, the LigaSure device was used to minimize thermal injury, and the wound was meticulously closed.
    RESULTS: Sternal wound infections developed in 3/166 (1.8%) patients; all three patients showed superficial sternal wound infections. Leg wound complications were present in 2/153 (1.3%) patients, who recovered after secondary intention healing.
    CONCLUSIONS: Sternal wound complications after CABG could be minimized by the unilateral ITA usage, meticulous closure of the sternal wound in addition to compliance with the current guidelines. Wound complications after NT SV harvest may also be minimized by preoperative evaluation, careful harvesting, and meticulous wound closure.
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