The Annals of Thoracic Surgery, Vol 48, 624-627, Copyright © 1989 by The Society of Thoracic Surgeons
Nonreversed saphenous vein grafts for coronary artery bypass grafting
JE Molina
Division of Cardiovascular and Thoracic Surgery, University of Minnesota Medical School, Minneapolis.
Between August 1985 and December 1988, valvotomized saphenous vein grafts
were used in 365 patients undergoing coronary artery bypass grafting
(CABG). In this operation, the femoral end of the vein is attached to the
aorta and the pedal end is attached to the coronary artery. Vein diameters
measured 8 +/- 2 mm at the femoral end, 4.5 +/- 1.2 mm at the knee level,
and 3.5 +/- 1.3 mm at the ankle. Ratios between levels were as follows:
knee to femoral end, 0.56, and ankle to femoral end, 0.43. The ratio of
knee to femoral end was 0.42 in cases with vein midthigh bifurcation. There
were 1,310 grafts implanted (3.6 per patient). In 341 patients, CABG alone
was performed, and 24 patients had combined procedures: 11 had CABG with
mitral valve replacement, 9 had CABG with aortic valve replacement, 2 had
CABG with repair of postinfarct ventricular septal defect, and 2 had CABG
with automatic defibrillator implantation. Follow-up (up to 3.5 years) was
attained in 97% of patients. For various reasons, 34 patients had a second
angiogram between 3 and 41 months postoperatively. Of 120 vein grafts, 108
(90%) were patent. At autopsy, 11 patients with 45 vein grafts had 43
patent and clean grafts and two thrombosed. Use of nonreversed saphenous
vein for coronary bypass is recommended. It assures a large proximal
anastomosis, natural vein bifurcations can be used with fewer proximal
anastomoses, better vein-coronary artery size matching is obtained, and the
patency rate is satisfactory.
