cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2019-34-1-24-32cardiotomsk-674Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESВЕНОЗНЫЕ КОНДУИТЫ В КОРОНАРНОЙ ХИРУРГИИ: СТАРЫЕ ПРОБЛЕМЫ — НОВЫЕ РЕШЕНИЯVENOUS CONDUITS IN CORONARY SURGERY: OLD PROBLEMS — NEW SOLUTIONSВечерскийЮ. Ю.VecherskiyY. Y.

д-р мед. наук, ведущий научный сотрудник отделения сердечно-сосудистой хирургии, Научно-исследовательский институт кардиологии,

634012, Томск, ул. Киевская, 111а

Dr. Sci. (Med.), Leading Research Fellow, Department of Cardiovascular Surgery, Cardiology Research Institute,

111a, Kievskaya str., Tomsk, 634012

vjj@cardio-tomsk.ruМанвелянД. В.ManvelyanD. V.

аспирант отделения сердечнососудистой хирургии, Научно-исследовательский институт кардиологии,

634012, Томск, ул. Киевская, 111а

Postgraduate Student, Department of Cardiovascular Surgery, Cardiology Research Institute,

111a, Kievskaya str., Tomsk, 634012

manvello9@yandex.ruЗатолокинВ. В.ZatolokinV. V.

канд. мед. наук, младший научный сотрудник отделения сердечно-сосудистой хирургии, Научно-исследовательский институт кардиологии,

634012, Томск, ул. Киевская, 111а

Cand. Sci. (Med.), Research Assistant, Department of Cardiovascular Surgery, Cardiology Research Institute,

111a, Kievskaya str., Tomsk, 634012

zatolokin@cardio-tomsk.ruШипулинВ. М.ShipulinV. M.

д-р мед. наук, профессор, заведующий отделением сердечно-сосудистой хирургии, Научно-исследовательский институт кардиологии,

634012, Томск, ул. Киевская, 111а

Dr. Sci. (Med.), Professor, Head of the Department of Cardiovascular Surgery, Cardiology Research Institute,

111a, Kievskaya str., Tomsk, 634012

shipulin@cardio-tomsk.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2019190420193412432Copyright © Вечерский Ю.Ю., Манвелян Д.В., Затолокин В.В., Шипулин В.М., 20192019Вечерский Ю.Ю., Манвелян Д.В., Затолокин В.В., Шипулин В.М.Vecherskiy Y.Y., Manvelyan D.V., Zatolokin V.V., Shipulin V.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/674

Появление аутовенозного аортокоронарного шунтирования (АКШ) ознаменовало эпоху хирургической реваскуляризации у больных с ишемической болезнью сердца, что обеспечило эффективное лечение стенокардии и значительно улучшило долгосрочный прогноз. Венозные трансплантаты на сегодняшний день остаются наиболее востребованными кондуитами в коронарной хирургии в силу доступности, простоты выделения и отсутствия ограничений по длине. Несмотря на преимущества аутовенозного АКШ, главным недостатком является высокая частота дисфункции (недостаточности) венозных кондуитов, представляющая важную и нерешенную проблему в кардиологической и кардиохирургической практике. С другой стороны, традиционное выделение большой подкожной вены (БПВ) подразумевает рассечение мягких тканей на протяжении всей длины выделяемого кондуита и приводит к длительному стойкому болевому синдрому после операции, частым нарушениям кожной чувствительности и высокой частоте раневых осложнений со стороны нижних конечностей. Это удлиняет сроки реабилитации больных и ухудшает качество жизни. Существует подход выделения вены в блоке с окружающими тканями для оптимизации длительного функционирования венозного шунта, но данная методика еще более травматична по сравнению с традиционным методом, в связи с чем ее применение на практике ограничено. Появление минимально инвазивных методов выделения позволило сократить частоту раневых осложнений и улучшить косметический результат, однако нет убедительных данных об их влиянии на состоятельность шунтов в отдаленном периоде после операции. Проблемы использования венозных кондуитов при АКШ многогранны, а их решение необходимо для улучшения эффективности хирургической реваскуляризации.

The introduction of autovenous coronary artery bypass grafting (CABG) marked the era of surgical revascularization in patients with coronary artery disease. It provided effective treatment for angina and significantly improved the long-term prognosis. Venous transplants today remain the most popular conduits in coronary surgery due to their availability, ease of harvesting, and the absence of length restrictions. Despite the advantages of autovenous CABG, the main disadvantage is the high incidence of venous graft failure, which represents an important and unresolved problem in cardiac and cardiovascular surgery. On the other hand, the traditional allocation of a large saphenous vein implies the dissection of soft tissues throughout the length of the isolated conduit. Traumatic dissection causes a long-lasting persistent pain syndrome after surgery, frequent abnormalities in  skin sensitivity, and a high incidence of wound complications in the lower extremities. These complications lengthen the period of rehabilitation of patients and worsen the quality of life. There is an approach of isolating the vein in a block with surrounding tissues to optimize the long-term functioning of the venous shunt, however, this technique is even more traumatic than the traditional method, and therefore its use is limited in practice. On the other hand, the introduction of minimally invasive methods of isolation allowed to reduce the incidence of wound complications and to improve the cosmetic result, but there is no convincing data regarding the effect on the consistency of shunts in the long-term postoperative period. The problems associated with the use of venous conduits in CABG are multifaceted, and their solutions are necessary to improve the effectiveness of surgical revascularization.

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The authors declare that there are no conflicts of interest present.