Mid-term Patency Rates Research Articles

The fate of the radial artery conduit in coronary artery bypass grafting surgery

Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Impressive long-term disease-free patency rate of the left internal thoracic artery-left anterior descending coronary artery (LITA-LAD) graft, coupled with proven long-term survival benefits, has led to its becoming a 'golden standard' of CABG. Previous long-term studies have also shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularization, compared with internal thoracic artery grafts. Thus, the use of arterial conduits has expanded beyond the internal thoracic arteries (ITAs) to include the right gastroepiploic artery, the inferior epigastric artery, and the radial artery. The assumption is that although the performance of one or two arterial ITA graft is superb, more arterial grafts should perform better in the long-term follow-up. Several studies concerning the use of the radial artery bypass grafts have documented excellent clinical results and satisfactory short-term as well as mid-term patency rates at restudy angiography, supporting its continued use as a bypass conduit. However, a note of caution concerning radial artery conduit patency rate have appeared in few recent reports. Thus, in this paper, we summarize the current evidence about the radial artery as a conduit in CABG surgery, with special emphasis on the clinical results.

Mid-Term Angiographic Comparison of Sequential and Individual Anastomosis Techniques for Diagonal Artery

The mid-term patency rates for individual and sequential grafts as coronary bypass conduits for diagonal arteries were angiographically compared; the impact of native coronary vessel and type of the conduit characteristics are investigated. Between March 1992 and April 2000, we performed a total number of 811 distal anastomosis on diagonal arteries of left anterior descending (LAD) artery in 296 patients who underwent coronary artery bypass surgery (CABG) distal anastomosis in our clinic. The patients were divided into two groups in this prospective study. In group A (n = 195) individual anastomosis technique, in group B (n = 101) sequential anastomosis technique was chosen as the myocardial revascularization strategy. At an average of 49.4 +/- 13.2 months after coronary revascularization procedure coronary angiographies were evaluated. Individual and sequential grafting techniques were compared by graft patency rates. The patency rates of sequential conduits were markedly higher than those of individual conduits (66.7% vs. 89.2%, p = 0.0001). This difference was also clear in coronary arteries with poor quality and small (<1.5 mm) diameter (49.1% vs. 66.6%, p = 0.032). Also, the patency rates of sequential radial artery conduits were higher than sequential saphenous vein graft (SVG) conduits (sequential radial artery; 94.1%, sequential SVG; 85.3%, p = 0.043). Sequential grafting for diagonal artery is technically more demanding but the mid-term results are better than individual grafting especially in coronary arteries with poor quality. Using radial artery as a sequential graft increases the mid-term graft patency rates.

Mid-term results of endovascular treatment for symptomatic chronic nonmalignant iliocaval venous occlusive disease

The goal of this article is to present clinical and patency results of endovascular treatment of nonmalignant, iliocaval venous obstructive disease and to discuss the evolution of technical details. From November 1995 to June 2004, 44 patients (female-male ratio, 3.9:1; left-right lower limb ratio, 8.6:1; median age, 42 years; range, 21-80 years) had treatment for chronic disabling obstructive venous insufficiency with iliocaval stenosis or occlusion. The clinical class of CEAP was 2 in 11 limbs, 3 in 31, 4 in 4, 5 in 1, and 6 in 1; etiology was primary in 32 patients, secondary in 10, and congenital in 2. Anatomic involvement included superficial veins in 16 patients and perforator veins in 11. Obstruction was associated with superficial reflux in 4 patients, deep reflux in 13, and both in 13. Ten patients had occlusion. All procedures were performed in the operating room with perioperative angiography and angioplasty with or without self-expanding stent implantation. Venous clinical severity and disability scores were obtained before and after treatment. Patency and restenosis were evaluated by duplex Doppler ultrasonography. No perioperative death or pulmonary embolism occurred. The technical success rate was 95.5% (two recanalization failures), and two (4.5%) perioperative stent migrations occurred. One early thrombosis (2.4%) was treated by thrombectomy and creation of an arteriovenous fistula. One late death and one thrombosis occurred. Restenoses were found in five patients and were all treated successfully (four needed iterative stenting). Median follow-up was 27 months (range, 2-103 months). Median venous clinical severity score improved from 8.5 to 2, and median venous disability score improved from 2 to 0. Cumulative primary, assisted primary, and secondary patency rates of the venous segments at 36 months were 73%, 88%, and 90%, respectively, in intention to treat. The survival rate was 100% at 12 months and 97.3% at 60 months. Endovascular treatment of benign iliocaval occlusive disease is a safe and efficient minimally invasive technique with good mid-term patency rates. Moreover, it improves cases with obstruction only, as well as cases with associated reflux and obstruction. Primary stenting should always be performed by using self-expanding stents deployed under general anesthesia to avoid lumbar pain. In case of failure, the endovascular procedure does not preclude further surgical reconstruction.

Prospective Evaluation of the St. Jude Medical Aortic Connector for Aortic-to-Autologous Vessel Graft Anastomoses

: Evolving technologies of proximal anastomosis devices meet the endeavor of surgeons to minimize manipulation of the ascending aorta during surgical myocardial revascularization. The objective of this study was to compare the patency rate of the saphenous vein coronary bypass grafts in which the proximal anastomoses were performed with automatic connector devices to the suture technique. : From September 2002 through July 2003, 86 patients underwent coronary artery bypass grafting with at least 1 vein graft anastomosed to the ascending aorta with the Symmetry G2 connector. Six-month clinical and angiographic follow-up, including Core-Lab quantitative coronary angiography (QCA) and corrected TIMI frame count (CTFC), was performed. : Eighty patients had at least 1 connector successfully implanted. Freedom from MACE (cardiac mortality myocardial infarction and target vessel reintervention) was 72/80 (90%). Six patients underwent a target vessel reintervention on the connector grafts. Six-month (mean 193 ± 36 days) angiography patency rates for the connector grafts were 72/81 (88.89%), 37/40 (92.5%) in sutured grafts, and 60/62 (96.8%) in arterial grafts. By QCA, 64/65 (98.5%) patent connector-grafts were free from more than 50% stenosis (1 connector-graft with a 51% stenosis). CTFC showed 65/65 (100%) patent connector-grafts with nonrestrictive flow. : Saphenous vein grafts anastomosed to the aorta with the Symmetry G2 connector have early and midterm patency rates comparable to the conventional sutured anastomoses. These results support the efficiency of the second generation of symmetry aortic connectors.

Early and midterm patency of the proximal anastomoses of saphenous vein grafts made with a Symmetry Aortic Connector System

The purpose of this study was to investigate (1) the early and midterm patency rates in saphenous vein grafts that were anastomosed with the Symmetry Aortic Connector System (St Jude Medical, Inc, St Paul, Minn) and (2) risk factors for graft occlusion. Thirty-one patients underwent off-pump coronary artery bypass grafting for proximal saphenous vein graft anastomoses with the aortic connector system. Intraoperative graft flow was studied with transit time flowmetry, and angiography was performed before discharge in 29 cases. Midterm (at least 1 year after the operation) saphenous vein graft patency was assessed by coronary angiography or 3-dimensional coronary computed tomography in 27 cases. Postoperative angiography demonstrated a 100% patency rate and no significant stenosis at the connector-anastomosed sites. The 1-year patency rate of the saphenous vein grafts with the aortic connector system was 92.6%, with 2 cases of saphenous vein graft occlusion. Both of these cases had low graft flow and poor left ventricular function documented during the operation. Once surgical errors had been ruled out, the 1-year patency rate of proximal saphenous vein grafts anastomosed with the aortic connector system was favorable. Poor left ventricular function and low graft flow during the operation were risk factors for midterm graft occlusion. Selection of the target vessel and its runoff may also be an important determinant of long-term patency.

Tissue engineered conduits for aortocoronary bypass grafting: midterm patency rates

Tissue engineered conduits for aortocoronary bypass grafting: midterm patency rates

Early and Mid-Term Outcome of Anastomosis of Gastroepiploic Artery to Left Coronary Artery

The performance of a bypass made to the left coronary artery using the gastroepiploic artery was examined. Sixty-nine cases of bypass operation in which the gastroepiploic artery had been anastomosed to the left coronary artery at least 3 years prior were examined. All cases were performed by the same surgeon during the period from April 1989 to April 2000. Performance immediately after the operation and performance at least 3 years after the operation were examined on the basis of graft patency rate. Graft patency rates in cases with an anastomosis to the left anterior descending coronary artery and cases with an anastomosis to the circumflex artery were favorable immediately after the operation, at 96.0% (24 of 25) and 100% (18 of 18), respectively. However, over the mid-term, the patency rate dropped to 58.8% (10 of 17) in cases with an anastomosis to the left anterior descending artery, and two cases of cardiogenic sudden deaths occurred during the course of follow-up. The graft patency rate in cases with an anastomosis to the circumflex artery, on the other hand, remained favorable, at 93.3% (14 of 15). In a sequential bypass grafting through the right coronary artery, the graft between the left anterior descending coronary artery and the right coronary artery was closed, and the graft patency rate between the right coronary artery and the circumflex artery was 71.4% (10 of 14). The mid-term patency rate was poor for cases in which the gastroepiploic artery had been anastomosed to the left anterior descending coronary artery, which suggests that the procedure should be avoided. On the other hand, the patency rate was relatively favorable when the gastroepiploic artery had been anastomosed to the circumflex artery.

Treatment of Popliteal Aneurysms With the Hemobahn Stent-Graft

The authors report a prospective study that determines the results of the use of a self-expanding stent-graft to treat 23 popliteal aneurysms in 21 patients over a 3-year period. Occlusion of the stent-graft and limb loss were outcome measures. Duplex scanning, ankle-brachial index measurements, and radiographic examination of the knee were used during follow-up evaluation. The procedure to place the stent-graft and exclude the aneurysm was technically successful in all patients. The cumulative patency over 15 months of follow-up was 74% as 5 of the 23 stent-grafts occluded within six months after the intervention. Of these, two were successfully recanalized and none of the five patients required amputation. The authors conclude that endovascular stent-graft repair of popliteal artery aneurysms is feasible; however, traditional surgical repair has a better midterm patency rate.

Laparoscopy-assisted reconstruction to treat severe aortoiliac occlusive disease: early and midterm results

Objectives The purpose of this study was to evaluate the consequences on patient selection and on early and midterm results of the learning curve of a surgical team performing laparoscopy-assisted surgery in the treatment of severe aortoiliac occlusive disease (AIOD). Patients and method Between January 1998 and June 2003, 58 patients (53 men, 5 women; mean age, 59.5 years [range, 37-76 years]) were included in a prospective study and underwent a laparoscopy-assisted aortofemoral reconstruction with graft implantation through a 5-cm to 8-cm minilaparotomy. Fifty-one patients (88%) had claudication (category 2 or 3, Rutherford classification), and seven patients (12%) had tissue loss; at presentation they had TransAtlantic Inter-Society Consensus C (n = 24, 41.4 %) or D (n = 32, 55.2%) iliac lesions, and the last 2 patients (3.4%) had severe aortic lesions. Perioperative data for the first 29 patients, obtained during the first 34 months of the study (group 1), were compared with data for the last 29 patients, obtained during the last 32 months of the study (group 2). Follow-up consisted of clinical examination or duplex scanning, or both, at 1, 3, 6, and 12 months and yearly thereafter, and computed tomography before discharge and then every 2 years. Results One intraoperative surgical conversion (1.7%) was necessary, and two other patients (3.4%) died in the immediate postoperative period. With experience, initial contraindications such as obesity or suprarenal artery aortic clamping were eliminated, making it possible to increase the percentage of patients included, from 53.7% during the first 34 months to 90.6% during the last 32 months ( P = .003). The mean duration of the operative procedure decreased from 285 minutes in group 1 to 192 minutes in group 2 ( P < .001), and the mean duration of aortic clamping decreased from 76.4 minutes in group 1 to 31.8 minutes in group 2 ( P < .001). The number of early repeat interventions was reduced from three (10.3%) in group 1 to 2 (6.9%) in group 2 ( P = NS), and the clinical recovery period decreased from 7 days to 4.5 days ( P = .05). During a mean follow-up of 26.7 months (range, 1-66 months) there were 5 repeat surgeries (9%) to treat late graft occlusion, establishing midterm primary and secondary patency rates of 89.3% and 91%, respectively. No aortic false aneurysms were detected, and no major amputations were performed. Conclusion These preliminary results assess the feasability and the safety of this minimally invasive video-assisted technique. A short period of postoperative recovery and good midterm patency rate are the two main benefits of this new surgical option.

Endovascular Management of Iliac Vein Occlusive Disease

Iliac vein occlusive disease presents with either acute or chronic symptoms, both of which can be managed with endovascular techniques. This report summarizes our experience in a small cohort of patients undergoing percutaneous treatment of iliac vein occlusive disease. Six women and one man with occlusive lesions in the iliac veins are included in this report. All patients reported leg pain and swelling, involving the right leg in one and the left leg in six. Symptoms were acute in one patient and chronic in six. Two patients presented with a chronic stasis ulcer. All patients with chronic symptoms were treated with self-expanding stents deployed across the occlusive lesion. The patient with acute symptoms was treated successfully with thrombolysis, which uncovered a fixed stenosis that was then stented. Post-procedure follow-up with duplex scanning was used for vein patency. No significant complications occurred. All patients reported symptomatic improvement, with four having complete resolution. Duplex scanning showed all treated venous segments to be patent at a mean of 12 months. Recanalization of obstructed iliac vein segments can be performed successfully and leads to improvement in pain and edema in the affected limb. Midterm patency rates are excellent.

Treatment of popliteal artery aneurysms with the Hemobahn stent-graft.

To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft. In a recent 3-year period, 21 patients (18 men; median age 67 years, range 52-82) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up evaluation included duplex scanning, ankle-brachial index (ABI) measurements, and radiographic examination of the knee. Outcome measures were occlusion of the stent-graft and limb loss. Technical success in placing the stent-graft and excluding the aneurysm was 100%. An additional vascular intervention was performed in the same session in 5 (24%) cases. In the other 16 patients, local anesthesia was used in 10 (63%). During a median follow-up of 15 months (range 2-37), 5 (22%) of 23 stent-grafts occluded, resulting in a cumulative patency of 74%. All occlusions occurred within 6 months after the intervention; 2 were successfully recanalized, and none of the 3 patients with persisting occlusion required an amputation. The results of this study suggest that endovascular stent-graft repair of popliteal artery aneurysms is feasible. Midterm patency rates are lower compared to traditional surgical repair.

Maintenance therapy with infliximab in the management of fistulous Crohn’s Disease

We have previously demonstrated excellent mid-term patency rates following routine venography after first rib resection and scalenectomy (FRRS) for subacute Paget-Schroetter syndrome. The goal of this study was to assess the long-term outcomes of this technique.Retrospective analysis of a prospectively collected database was performed. Patients underwent routine venography 2 weeks post-FRRS. Warfarin was discontinued in those with patent veins. Patients with stenotic or occluded veins underwent attempted venoplasty with balloon diameters approximating the size of the anatomically normal vein. Patients with successful venoplasty or chronically occluded veins unable to be dilated were continued on warfarin up to 6 months. Follow-up duplex ultrasound dictated cessation of anticoagulation. Kaplan-Meier analysis was performed for primary, primary-assisted, and secondary patency.A total of 159 patients underwent FRRS and postoperative venography with a median follow-up of 13.8 months. One patient was lost to follow-up. The median time to FRRS after the initial onset of symptoms was 4.1 months. At the time of venography, there were 42 patent, 72 stenotic, and 44 occluded veins. Of the 44 occlusions, 25 underwent venoplasty, and 19 could not be crossed. In the entire group, restenosis occurred in seven patients and reocclusion in seven. At last follow-up, six patients remained occluded. Eighteen-month primary patency of venoplasty was 95.4% ± 2.6% in the stenotic group and 75.6% ± 8.7% in the occluded group. Eighteen-month primary-assisted patency of venoplasty was 98.3% ± 1.7% in the stenotic group and 96.0% ± 3.9% in the occluded group. Overall secondary patency at 3 years was 100% in the patent group, 98.4% ± 1.6% in the stenotic group, and 92.9% ± 3.9% in the occluded group.Long-term venous patency rates after limited venoplasty and anticoagulation following FRRS are excellent. Furthermore, prolonged anticoagulation for occlusions that could not be crossed or in those who reocclude after venoplasty results in recanalization and delayed patency. These results argue against the need for stenting or open venous reconstruction and serve as a benchmark for the care of patients with subacute Paget-Schroetter syndrome.

Treatment of Complex Arteriosclerotic Lesions with Nitinol Stents in the Superficial Femoral and Popliteal Arteries: A Midterm Follow-up

To evaluate the effectiveness of nitinol stents in patients with short, complex lesions in the superficial femoral and popliteal arteries and to assess midterm results. Self-expandable nitinol stents were implanted in 54 extremities in 44 patients to treat complex stenoses (n = 32) and occlusions (n = 22) in the superficial femoral and popliteal arteries. Follow-up was performed for 5-51 months to evaluate early thrombosis and midterm patency rates. Midterm patency rates were compared between the following: stenoses and occlusions, proximal and distal locations, good and poor runoff, and diabetic patients and nondiabetic patients. All patients underwent clinical investigation and color Doppler sonography after 1 month and 6 months and at 6-month intervals thereafter. If restenosis or stent thrombosis was suspected, intraarterial digital subtraction angiography of the superficial and popliteal arteries was performed. Percutaneous stent implantation was successful in all patients. The mean duration of follow-up was 27 months (range, 5-51 months). No thrombotic occlusion occurred within the first 4 weeks after stent implantation. The primary 3-year patency rate was 76%, and the secondary patency rate was 87%. Three-year primary patency rates were 65% for diabetic patients and 82% for nondiabetic patients. In patients with short, complex stenoses and occlusions, implantation of nitinol stents may have a positive impact on midterm results.

Endovascular strategies for superior vena cava obstruction

The symptoms of superior vena cava (SVC) obstruction can be extremely debilitating, and current medical and surgical treatments have been only partially successful in providing relief to afflicted patients. Endovascular techniques of venous recanalization have recently shown excellent short-term and mid-term success in patients with both benign and malignant causes of SVC obstruction. Endovascular therapy may be reasonably used as a first-line approach to the palliation of malignant SVC obstruction, and its mid-term patency rates compare favorably with those of modern surgical methods of venous bypass in patients with benign SVC obstruction. In this article, the percutaneous management: of SVC syndrome is discussed, with particular attention to the anatomical considerations and clinical priorities that impact endovascular decision making.

The Importance of Revision of Early Restenosis after Endovascular Remote Endarterectomy in SFA Occlusive Disease

Objectives: to investigate the results of revision of recurrent stenoses after superficial femoral artery (SFA) remote endarterectomy. Design: prospective, non-open, study. Materials: eighty-eight consecutive patients with long segmental SFA occlusive disease underwent 101 remote endÍarterectomy procedures. All patients had chronic lower extremity ischaemia necessitating surgical intervention. Methods: clinical, haemodynamic, and duplex examinations were performed postoperatively at regular intervals, identifying 46 recurrent stenosed (PSV ratio >2.5) limbs, which formed the cohort for this study. The median follow-up was 25 months. Secondary revision was performed in 23 limbs, based on recurrent symptoms and individual preference of the attending vascular surgeon. Cumulative primary and primary assisted-patency rates were compared using the log-rank test of significance. Results: univariate analysis did not show any significant differences for other demographic and lesion characteristics apart from recurrent symptoms (all revised). Multivariate analysis revealed that revision “adjusted for time-of-onset” predicted reocclusion (p=0.007; HR 0.21; 95% CI 0.06, 0.66). Among subjects in whom restenoses developed within 1 year, revision of recurrent stenoses improved primary patency rates from 47% to 77% at 30 months. Conclusions: revision of early (<1 year) recurrent stenoses improves the mid-term patency rates of SFA remote endarterectomy.

Immediate Stenting of Iliofemoral Occlusive Lesions: A Surgeon's Early Experiences

Purpose: To report the early and midterm results of balloon angioplasty and immediate stenting of atherosclerotic iliofemoral lesions in an operating room setting. Methods: Sixty-one patients (41 men, mean age 70 ± 8 years, range 49 to 86) underwent balloon dilation and systematic stenting for 80 stenotic and occlusive lesions in the iliac (n = 47) and superficial femoral (n = 33) arteries in 72 limbs. One hundred two stents (63 VascuCoil, 33 Wallstent, and 6 miscellaneous) were placed. Patients were followed with serial duplex scans at 3-month intervals. Results: Initial technical success by intention-to-treat was 96.2% (77/80) (iliac: 100%, femoral: 90.9% [30/33]). There were 9 (11.3%) procedure-related complications and no deaths. Initial success by anatomic, hemodynamic, and clinical limb criteria were 100%, 95%, and 94.4%, respectively. Thirty procedures were performed for limb salvage with a success rate of 86.7%. Six patients (7 limbs) died during follow-up of unrelated causes. Fifty-nine (81.9%) limbs were available for duplex follow-up over a mean 17.7 months (range 3 to 37). Cumulative patency rates were 87.3% at 2 years for iliac stents and 66.6% at 18 months for femoral stents with an overall 2-year patency rate of 76.3%. The only independent risk factors affecting late patency were the site of angioplasty, stent diameter, lesion grade, and the preoperative ankle-brachial index. Stents placed with a diameter ≤ 5 mm and &gt; 5 mm had 1-year patency rates of 51.0% and 97.6%, respectively (p = 0.004) Conclusions: Iliac and femoral angioplasty and immediate stenting have acceptable midterm patency rates. The patency of femoral stenting is inferior and is adversely affected by stents ≤ 5 mm in diameter.

Shredding Embolectomy Thrombectomy Catheter for Treatment of Acute Lower-Limb Ischemia

We undertook a prospective evaluation to prove a new mechanical thrombectomy device, the shredding embolectomy thrombectomy catheter (S.E.T. catheter), for the treatment of patients with acute lower-limb ischemia. The study evaluated the success, patency, mortality, limb salvage, and complication rates for 51 patients treated from January 1994 through June 1996, with this device, which was an 8-F three-lumen catheter. The onset of symptoms was 8.6 +/- 9 days. Thrombus length was 18 +/- 9 cm situated in 44 native vessels and in 7 bypasses, 42 limbs were graded as threatened. Hydromechanical thrombectomy with the S.E.T. catheter proved to be a quick and safe adjunct for therapy of acute femoropopliteal thromboembolic occlusions with a high initial success rate and an acceptable mid-term patency rate.

Radial artery in CABG: could the early results be comparable to internal mammary artery graft?

Background. The accidental detection of patency of radial artery grafts, by Acar, which had been labeled as blocked 18 years earlier, has led to its revival as a conduit in coronary artery bypass surgery. We used radial artery as one of the grafts in 287 patients from February 1996 to June 1998. Here we present our early clinical experience and the midterm angiographic follow up of the initial 62 patients. Methods. A no touch, atraumatic harvesting technique coupled with gentle hydrostatic and pharmacological dilatation of the radial artery graft was employed. Radial artery was used to revascularize coronary vessels with >80% proximal stenosis. Postoperatively, the patients were administered a low dose nifedipine that was continued for 6 months thereafter. The patients were followed up clinically after discharge from the hospital and angiographic evaluation of the grafted radial artery by selective injection was done at a mean interval of 16.2 ± 5.1 months (3–24 months) postoperatively. Results. There was no perioperative or late myocardial infarction or mortality. No significant complications related to the harvesting of radial artery were encountered. Angiographically, the radial artery grafts were found to be patent in 96.8% of patients (60/62). Mild distal anastomotic narrowing was seen in angiogram of one patient with good filling of the target vessel. Another patient showed diffuse spasm of radial artery graft. The patency of the pedicled left internal mammary grafts was also 98.2% (56/57). All the patients were asymptomatic. Conclusions. Radial artery seems to be an excellent alternate arterial conduit for myocardial revascularization with early and midterm patency rates equivalent to that of pedicled internal mammary artery, and it should be used more often for myocardial revascularization as an adjunct to pedicled internal mammary artery graft.

Inferior epigastric artery as a conduit for myocardial revascularization: a two-year clinical and angiographic follow-up

The inferior epigastric artery has been proposed as a suitable conduit for myocardial revascularization but its mid-term patency rate has not been assessed. A prospective clinical and angiographic study on the use of the inferior epigastric artery as an additional arterial conduit together with bilateral internal thoracic artery grafting was conducted in 38 patients. No deaths or major postoperative complications occurred. Twenty-three patients underwent repeat angiography after an average of 21.2 months. The left and right internal thoracic artery grafts patency rate was 95.6% (44/46), while inferior epigastric artery patency rate was 52.2% (12/23). By relating patency to the grafted coronary branch, the following results were obtained: 100% for the left anterior descending (3/3), right coronary (1/1) and ramus medianus (1/1); 40% (4/10) and 37.5% (3/8) for diagonals and obtuse marginals respectively. The low patency rates observed when the inferior epigastric artery is used on diagonals and obtuse marginals indicate that this vessel cannot be considered a suitable conduit for extensive application of arterial revascularization. We suggest that the inferior epigastric artery should only be used in patients presenting with contraindications to bilateral internal thoracic artery or right gastroepiploic artery grafting, or exhibiting unsuitable saphenous veins.

Use of the right gastroepiploic artery as a coronary artery bypass graft in 307 patients

From October 1988 to October 1995 the right gastroepiploic artery was used as a conduit for coronary surgery in 307 patients. Their average age was 56.5 years (range 25–75) and 274 patients (89%) were male. Twenty-six cases (8.5%) were re-operations and 58 patients (19%) were operated upon on an urgent or semi-urgent basis. Target coronary vessels were the right coronary artery and its branches in 280 cases (91.4%), the circumflex artery in 25 cases (8%) and the left anterior descending artery in two cases. The right gastroepiploic artery was used as an in situ graft in 303 cases (98.7%) and as a free graft in 4 (1.3%). A total of 291 patients (94.8%) also received at least one mammary artery graft: both mammary arteries were used in 167 patients (54.4%). An average of 3.6 distal anastomoses were made per patient, three of them with arterial grafts. Eleven (3.2%) right gastroepiploic artery grafts were doubled with saphenous vein intraoperatively because of persistent myocardial ischemia. In-hospital mortality was 1.6% (five patients). Perioperative myocardial infarction occurred in twelve patients (3.9%). Follow-up now averages 26 months (range 6–88). There have been five late deaths (1.6%). A total of 265 (89.2%) patients are angina free. Of the total, 145 patients have been investigated with a maximal-stress test coupled with scintigraphy: residual myocardial ischemia was found in 10 patients, right gastroepiploic artery was related in three. Ninety-six patients have undergone angiographic restudy at a mean of 12 months (range 8–88) postoperatively. Patency of the right gastroepiploic artery grafts was 91.8%. This study confirms that the right gastroepiploic artery can be used as a conduit for coronary artery bypass surgery with minimal mortality or morbidity. Mid-term patency rates and clinical outcome are encouraging.