{"title":"在左锁骨下动脉狭窄患者中使用 RIMA-LIMA-Y 配置进行全动脉再血管化。","authors":"Anit Kumar, Bharath Sundar, Swanand Khapli, Sayyed Azhar Salim Ahmed, Dhiraj Barman, Lalit Kapoor, Unmesh Chakraborty","doi":"10.1177/02184923241284318","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable.</p><p><strong>Methods: </strong>In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG.</p><p><strong>Results: </strong>The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well.</p><p><strong>Conclusion: </strong>The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. The importance of CT angiography of neck vessels to detect SAS cannot be under-emphasized.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":null,"pages":null},"PeriodicalIF":0.7000,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total arterial revascularization with RIMA-LIMA-Y configuration in patients with left subclavian artery stenosis.\",\"authors\":\"Anit Kumar, Bharath Sundar, Swanand Khapli, Sayyed Azhar Salim Ahmed, Dhiraj Barman, Lalit Kapoor, Unmesh Chakraborty\",\"doi\":\"10.1177/02184923241284318\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable.</p><p><strong>Methods: </strong>In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG.</p><p><strong>Results: </strong>The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well.</p><p><strong>Conclusion: </strong>The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. 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引用次数: 0
摘要
背景:接受冠状动脉旁路移植术(CABG)的患者中,有 6% 会出现锁骨下动脉狭窄(SAS)。锁骨下-冠状动脉盗血等并发症很常见。此类病例的血管重建方案仍有争议:在本病例系列中,所有心绞痛患者在血管造影检查中都有严重的三支血管病变。所有检查包括颈部血管的计算机断层扫描(CT)血管造影术,都是作为 CABG 常规检查的一部分进行的:患者均为男性,平均年龄为 66.5 岁,其中三人患有高血压和糖尿病。所有患者均已戒烟,平均射血分数(EF)为 60.1%。颈部血管 CT 血管造影显示,两名患者患有中度至重度狭窄,一名患者患有重度左侧 SAS 狭窄,另一名患者患有重度左侧乳内动脉 (LIMA) 近端狭窄。患者接受了全动脉血管再造术,平均移植了 3.5 条远端动脉。LIMA 移植采用 Y 型结构,与原位右乳内动脉 (RIMA) 吻合。所有患者术后均顺利出院,平均住院时间为 3.8 天。术后未发生中风、心肌梗死、神经症状或 EF 变化。随访6个月时,他们均无症状,情况良好:结论:RIMA-LIMA-Y配置是左侧SAS患者进行CABG的一种安全可行的选择。它具有挑战性,再次入路和合理利用 LIMA 长度至关重要。颈部血管 CT 血管造影对检测 SAS 的重要性不容忽视。
Total arterial revascularization with RIMA-LIMA-Y configuration in patients with left subclavian artery stenosis.
Background: Subclavian artery stenosis (SAS) occurs in 6% of patients undergoing coronary artery bypass grafting (CABG). Complications such as subclavian-coronary steal are common. Revascularization options in such cases remain debatable.
Methods: In this case series, all patients with angina, had severe triple vessel disease on angiography. All tests including computed tomography (CT) angiography of neck vessels, were done as part of routine workup for CABG.
Results: The patients, all males, had a mean age of 66.5 years with three of them having hypertension and diabetes. All were ex-smokers with mean ejection fraction (EF) of 60.1%. CT angiography of neck vessels revealed that two patients had moderate to severe while one had severe left SAS and another had severe proximal left internal mammary artery (LIMA) stenosis. Total arterial revascularization was performed, with an average of 3.5 distal grafts. The LIMA graft was employed in a Y graft configuration, anastomosed to in-situ right internal mammary artery (RIMA). All patients had uneventful postoperative stay and were discharged with a mean hospital stay of 3.8 days. There were no postoperative strokes, myocardial infarction, neurological symptoms, or change in EF. At 6-month follow-up, they were asymptomatic and doing well.
Conclusion: The RIMA-LIMA-Y configuration can be a safe, viable option in CABG for patients with left SAS. It is challenging, with re-entry and judicious utilization of the length of LIMA being of paramount importance. The importance of CT angiography of neck vessels to detect SAS cannot be under-emphasized.
期刊介绍:
The Asian Cardiovascular and Thoracic Annals is an international peer-reviewed journal pertaining to cardiovascular and thoracic medicine. Besides original clinical manuscripts, we welcome research reports, product reviews, reports of new techniques, and findings of special significance to Asia and the Pacific Rim. Case studies that have significant novel original observations, are instructive, include adequate methodological details and provide conclusions. Workshop proceedings, meetings and book reviews, letters to the editor, and meeting announcements are encouraged along with relevant articles from authors.