Summary
Surgical revascularization allows especially for the diabetic patient with coronary multi-vessel disease a superior long-termperspective compared to percutaneous coronary interventions. However, the specific advantages and also risks associated with the expanded use of arterial grafts as coronary conduits in diabetics are not clearly answered. A systemic analysis of the current literature underlines the following statements: The radial artery is, compared to the internal mammary artery, to a higher extent prone to atherosclerosis, especially in diabetic patients. Better long-term survival for patients with bilateral IMA-grafts has also been assessed for diabetic patients. The risk of thoracic wound infections is not obligatory increased for diabetics with double IMA-grafts. Revascularization with radial arteries can be performed with low perioperative risks. Long-term results or studies on radial artery bypass grafting especially in diabetics are not available. In our own experience (3,548 isolated coronary operations, 01/2001 until 05/2005), diabetic patients have no increased perioperative mortality, even when using more complex arterial grafting. Conclusively, diabetic patients should also significantly benefit from the use of the second mammary artery. Regarding conduit quality, a second IMA appears favorable over the radial artery.
Zusammenfassung
Gerade für den diabetischen Patienten mit koronarer Mehrgefäßerkrankung besitzen chirurgische Revaskularisationskonzepte entscheidende Überlebensvorteile im langfristigen Verlauf gegenüber perkutanen Revaskularisationsmaßnahmen. Welche Vorteile, aber auch Risiken der erweiterte Einsatz von arteriellen Grafts als Koronarbypass beim Diabetiker hat, ist bisher nicht klar formuliert. Eine systematische Analyse der aktuellen Literatur erbrachte folgende Ergebnisse: Die Radialarterie weist gegenüber Mammaria-Arterien in deutlich höherem Maße atherosklerotische Veränderungen mit besonderer Ausprägung beim Diabetiker auf. Der mit einer bilateralen Mammaria-Revaskularisation verbundene Überlebensvorteil gilt auch für Diabetiker. Das Risiko thorakaler Wundinfektionen ist dabei für den Diabetiker nicht zwangsläufig signifikant erhöht. Die Revaskularisation mit Radialarterien kann mit niedrigem perioperativem Risiko durchgeführt werden. Langzeitergebnisse oder Untersuchungen speziell zu Diabetikern liegen nicht vor. Im eigenem Krankengut (3 548 isolierte Bypassoperationen, 01/2001 bis 05/2005) haben Diabetiker insgesamt, aber auch bei komplexen Arterienkonzepten keine erhöhte perioperative Letalität. Letztlich dürften auch Diabetiker insbesondere von dem Einsatz der zweiten Mammaria-Arterie nachhaltig profitieren. Hinsichtlich der Konduiteigenschaften spricht vieles dafür, die zweite Mammaria-Arterie gegenüber der Radialarterie vorzuziehen.
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Cremer, J., Böning, A., Fraund, S. et al. Koronare Revaskularisation bei Diabetikern—. Clin Res Cardiol 95 (Suppl 1), i35–i39 (2006). https://doi.org/10.1007/s00392-006-1113-0
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DOI: https://doi.org/10.1007/s00392-006-1113-0