Avaliação angiografica precoce e tardia dos enxertos de arteria radial utlizada na revascularização cirurgica do miocardio

AUTOR(ES)
DATA DE PUBLICAÇÃO

2003

RESUMO

Background: The surgery of myocardial revascularization has presented great development in the last decades, leading to a search for grafts that may be easily and safely o btained to patients, that may be of easy handling to surgeons and that may present long lasting perviousness. The gold standard that has been established is based on the internal thoracic artery performance, and ITom these results other grafts have been evaluated as well. CARPENTIER (1973) introduced the radial artery as an option for the surgery of myocardial revascularization but, in 1975, the same author discouraged its use because of the poor results he had observed (35% of early occlusions). ACAR (1992) re-started the use of the radial artery after some technical changes on the graft dissection and preparation, achieving very successful results in the short run. We started the use ofthis graft in 1995, with favorable results as well, and the follow up of this initial group of patients originated this dissertation. Objective: To analyse the angiographic characteristics of the radial artery in the early and late period, relating the occurrence of spasm and or occlusion to the histopathological finding characteristics, patient gender and lesion degree in the revascularized coronary artery. Casuistic and Method: 120 patients (138 grafts) operated on between October 1995 and December 1996 received, at least, one radial artery graft, 82 (68,3%) were of the male gender, with average age of 57.9:i:8.8 years. Coronariographic study was performed in the early postoperatory (20 days average) in all patients, and afier a minimum period of 36 months / maximum 63 months (50.6 months average), 35 patients (41 grafis) accepted being submitted to a new coronariographic study. The analysis of the early and late studies was done seeking to evaluate, with greater emphasis, the cases with spasms in the early stage and occ1usions at the late stage. We have also established a relation among the cases that presented angiographic abnormalities and the histopathologic study ofthe radial artery, patient gender and lesion degree of the revascularized coronary artery.Results: An early perviousness of 95.6% of grafts and a prevalence of spasm in 10.9% of the radial arteries were found. Gender and histopathologic abnormalities were not found as predictors of early spasm. The female gender showed itself as an important factor in the occ1usion of grafts at the early stage (p=0.01). In the late studies there was a perviousness of 82.9% ofthe evaluated arteries; gender, histopathologic findings and lesion degree in the approached coronary artery were not associated to late occ1usion, but the evidence of early spasm presented an important relation to late occ1usion (p=0.01). Conclusion: Radial artery presented early and late perviousness with acceptable values when compared to specific literature of the subject. Early occ1usion was more prevalent on the female gender. Presence of spasm on the early study was associated with the occlusion on the late study. Abnormalities in histopathologic examination of the radial artery and the coronary artery with no relevant lesion did not present as being statistically significant in our study

ASSUNTO(S)

anatomia patologica oclusão espasmos

ACESSO AO ARTIGO

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