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관상동맥 우회술과 말초 혈관 협착의 동맥 우회술의 동시 수술
송현,이은상,유동곤,Song, Hyun,Lee, Eun-Sang,Yoo, Dong-Gon 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.10
There was no significant difference in morbidity and mortality between those that received simultaneous operation for coronary artery disease and peripheral vascular disease versus those that received coronary artery bypass graft alone. Simultaneous operation is also cost effective. A 46 year-old patient with resting chest pain and intermittent claudication was diagnosed as unstable angina and Leriche's syndrome. We performed simultaneous revascularization for coronary artery stenosis with internal mammary artery and right gastroepiploic artery and a bifurcated vascular graft interposition between in the aorta, left common iliac and right femoral arteries for Leriche's syndrome. The postoperative coronary angiogram and aortogram revealed a good patency of the arterial conduits and vascular graft. He has been followed for 12 months without any problem.
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관상동맥우회 이식편으로서의 우위대망동맥의 조직학적 특징
이현우,송현,유동곤,임한중,이재원,송명근,Lee, Hyun-Woo,Song, Hyun,Yoo, Dong-Gon,Lim, Han-Jung,Lee, Jae-Won,Song, Meong-Gun 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.10
Long term patency of arterial graft has been better than venous graft and redo coronary artery bypass grafting has been increasing, therefore, there has been an increasing need for alternative arterial grafts except internal thoracic artery(ITA). Material and Method: Right gastroepiploic arteries(RGEA) were harvested from 100 patients who had received gastrectomy for gastric cancer or ulcer. ITAs were obtained from 10 patients undergoing coronary artery bypass grafting. The length of RGEA was measured from the pyloric ring. Items of the morphometric and histologic study at the pyloric ring and sites of the 10cm and 20cm RGEA from the pyloric ring were luminal diameter, intimal thickness, medial thickness, wall thickness, degree of intimal hyperplasia, intimal thickness, medial thickness, wall thickness, degree of intimal hyperplasia, intimal thickness index, medial thickness index, and the number of discontinuities of the internal elastic lamina. Similar items were applied to the proximal site of ITAs. Result: The length of RGEA was 23${\pm}$2.7cm(range 17∼31cm). Comparing the 20cm RGEA with ITA, intimal thickness, medial thickness, wall thickness, and degree of intimal hyperplasia did not show any difference(p>0.05). However, 20cm RGEA was greater than ITA at the luminal diameter, intimal thickness index, and the number thickness and wall thickness in each site of the RGEA(pyloric ring, 10cm, 20cm) decreased from the pyloric ring to the distal sites(p<0.05). The degree of intimal hyperplasia and the number of discontinuities of the internal elastic lamina did not show any difference between the pyloric ring and 10cm, however, those of 20cm were smaller than these sites(p<0.05). RGEA had more number of discontinuities of the internal elastic lamina and rich smooth muscle cells in the media than ITA. Conclusion: The length and diameter of RGEA is good enough to reach most of the coronary arteries. Moreover, long term patency of RGEA may be improved, if anastomosed in the distal site.
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