John S Douglas   美国艾莫利大学医学院

    <International Circulation>: The presence of moderate saphenous vein graft lesions is a major predictor of late cardiac events after CABG. How do you deal with SVG lesions in clinical practice?

  《国际循环》：冠脉搭桥术后大隐静脉损伤（SVG）是晚期心血管事件的预测因子，您认为临床应如何处理SVG？

    Prof Douglas:  Generally， the presence of a moderate stenosis in a SVG (40-50% narrowing) is not an indication for PCI. Flow limiting stenoses which are causing angina or ischemia are the usual indications. If one encounters a moderate stenosis in a SVG that is receiving a stent because of a severe stenosis in another part of the SVG， many operators may stent the moderate stenosis as well because of the reported higher event rates. This is a practice however that is not supported by large randomized trials.

    Douglas教授: 一般而言，SVG中度狭窄（40-50%狭窄）没有经皮介入治疗的指证，引起心绞痛或心肌缺血的狭窄才有PCI治疗的必要。SVGZ中度狭窄的介入治疗往往是为SVG中更重狭窄处行PCI治疗的铺垫，而多数术者对这些病变PCI治疗的原因在于减少远期心血管事件。这些治疗仅仅是经验性的，并没有大规模随机对照研究的支持。

    <International Circulation>: What are the major risks of SVGs interventional treatment? Are there effective approaches to treat these risk factors?

  《国际循环》：SVG的介入治疗有哪些风险？如何有效处理这些危险因素？

    Prof Douglas: The most common complication is myocardial infarction caused by atherosclerotic plaque material liberated from the wall of the SVG at the time of stent implantation. These MIs are usually small but can be large if there is a lot of plaque in the SVG (either due to diffuse disease or the presence of a bulky lesion - therefore characteristics of the SVG can be predictive of MI). Use of filters to catch the atheroembolic material can reduce MI rates by about 50%. Rupture of SVGs can occur rarely and I caution against oversizing stents.

    Douglas教授: SVG支架植入过程中静脉管壁粥样斑块相关的心肌梗死是该手术最常见的并发症。这种心肌梗死面积一般较小，较大的心肌梗死往往与SVG斑块较多有关（多见于弥漫或大块病变）。远端保护的滤网可以有效降低这种心肌梗死50%的发生率。SVG术中破裂较少见，应慎重选择支架避免支架过大引起血管破裂。