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The Annals of Thoracic Surgery, Vol 52, 429-436, Copyright © 1991 by The Society of Thoracic Surgeons
HB Barner, KS Naunheim, AC Fiore, VW Fischer and HH Harris
From March 1990 through January 1991, 47 patients undergoing myocardial
revascularization had one (37) or both (10) inferior epigastric arteries
(IEA) used as a conduit for bypass with 62 distal anastomoses. The internal
thoracic artery (ITA) was used bilaterally in 41 patients and unilaterally
in 6 with 100 distal anastomoses. Five patients had a single saphenous vein
graft. In total, 167 anastomoses (3.55 per patient) were performed. Single
IEA grafts were harvested through a paramedian incision and bilateral
grafts, a midline incision. Harvest time was 36.5 minutes for IEA grafts
and 29.6 minutes for ITA grafts (p less than 0.0001). Graft length was 11.9
cm for IEA grafts and 16.5 cm for ITA grafts (p less than 0.0001). Distal
graft diameter was 2.0 mm for IEA grafts and 2.1 mm for ITA grafts (p less
than 0.01). Graft flow was 49.7 mL/min for IEA grafts and 48.7 mL/min for
ITA grafts. Microscopic assessment of segments of both the IEA and ITA from
14 patients revealed similar internal elastic laminae and an equal number
of fenestrations. Combined intimal and medial thickness was comparable in
both conduits. Medial elastic tissue was more prominent in ITA grafts and
lacking in eight of the 14 IEA grafts. Gross plaque formation was noted in
the proximal 1 to 3 cm of 50% of IEA grafts, but the lumen was not
compromised and microscopic thickening was minimal. An unexpected finding
was medial calcifications (Monckeberg's disease) in two of the 14 IEAs
without associated atherosclerosis. There was one hospital death, one
abdominal wound infection, and one instance of fat necrosis superficial to
the sternum.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Use of the inferior epigastric artery as a free graft for myocardial revascularization
Department of Surgery, St. Louis University School of Medicine, Missouri.
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