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The Annals of Thoracic Surgery, Vol 52, 1187-1189, Copyright © 1991 by The Society of Thoracic Surgeons

ARTICLES

Endarterectomy, vein patch, and mammary bypass of the anterior descending artery

JS Ladowski, MH Schatzlein, DJ Underhill and AC Peterson
Northern Indiana Heart Institute, Fort Wayne.

Occasionally the left anterior descending (LAD) coronary artery contains such diffuse calcific atherosclerosis that an area suitable for distal anastomosis with the internal mammary artery (IMA) cannot be found. Additionally, the LAD of some patients contains multiple areas of stenosis, which would prevent free outflow from the IMA graft. In these cases the potentially increased operative risk of LAD endarterectomy is justified to avoid leaving poorly revascularized areas of anteroseptal heart. In an effort to provide the long-term patency benefits of IMA grafting for these patients without the technical difficulty of a lengthy IMA to LAD anastomosis, we have combined saphenous vein patch reconstruction with IMA bypass when LAD endarterectomy is required.

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