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ВЕНОЗНЫЕ КОНДУИТЫ В КОРОНАРНОЙ ХИРУРГИИ: СТАРЫЕ ПРОБЛЕМЫ — НОВЫЕ РЕШЕНИЯ

https://doi.org/10.29001/2073-8552-2019-34-1-24-32

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Аннотация

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.

Об авторах

Ю. Ю. Вечерский
Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук
Россия

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

634012, Томск, ул. Киевская, 111а



Д. В. Манвелян
Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук
Россия

аспирант отделения сердечнососудистой хирургии, Научно-исследовательский институт кардиологии,

634012, Томск, ул. Киевская, 111а



В. В. Затолокин
Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук
Россия

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

634012, Томск, ул. Киевская, 111а



В. М. Шипулин
Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук
Россия

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

634012, Томск, ул. Киевская, 111а



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Для цитирования:


Вечерский Ю.Ю., Манвелян Д.В., Затолокин В.В., Шипулин В.М. ВЕНОЗНЫЕ КОНДУИТЫ В КОРОНАРНОЙ ХИРУРГИИ: СТАРЫЕ ПРОБЛЕМЫ — НОВЫЕ РЕШЕНИЯ. Сибирский медицинский журнал. 2019;34(1):24-32. https://doi.org/10.29001/2073-8552-2019-34-1-24-32

For citation:


Vecherskiy Y.Y., Manvelyan D.V., Zatolokin V.V., Shipulin V.M. VENOUS CONDUITS IN CORONARY SURGERY: OLD PROBLEMS — NEW SOLUTIONS. The Siberian Medical Journal. 2019;34(1):24-32. (In Russ.) https://doi.org/10.29001/2073-8552-2019-34-1-24-32

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