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Ann Thorac Surg 1998;66:1847
© 1998 The Society of Thoracic Surgeons

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Updates

Use of the Inferior Epigastric Artery as a Free Graft for Myocardial Revascularization

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

Address reprint requests to Dr Barner, Division of Cardiothoracic Surgery, Washington University, One Barnes-Jewish Hospital Plaza, Suite 3108, St. Louis, MO 63110
e-mail: (Barnerh.msnotes.wustl.edu)

After our initial report we doubled our experience with substantially the same results [1] but were unable to obtain other than anecdotal angiographic follow-up. Fortunately early- and intermediate-term angiography has been obtained in the largest series of inferior epigastric artery (IEA) grafts reported [2]. Early angiography in 154 of 187 patients at 10.14 ± 4.4 days revealed patency in 97.4%, with perfect patency (no string sign and no stenosis) in 92%. Midterm (12.5 ± 6.6 months) patency in 87 patients was 91%. In 4 of 8 occluded grafts and 8 of 11 string-sign grafts the recipient coronary artery had a 60% or less stenosis (none of these closed or narrowed grafts were detected at early angiography). Additionally there were four stenoses; one in the mid-graft and three of the distal anastomosis for a perfect patency of 74%. If the 4 occlusions and 8 string signs are excluded, perfect angiography patency was 88%. Overall patency in patients studied 13 to 43 months postoperatively was similar to that in patients restudied at 6 to 13 months with 1 of 29 occluded and 3 of 29 diffusely narrowed, for an 86% patency. Thus, patency for the IEA is comparable to that for the free internal thoracic artery [3].

Interestingly, the best patency has been reported by Calafiore and colleagues, who place the proximal anastomosis to an situ internal thoracic artery rather than the aorta [4]. Of 85 IEA conduits having a proximal Y-anastomosis, 34 of 34 were patent at 7 to 15 days and 20 of 21 (94.1%) at 6 to 14 (mean 9.5) months [4]. Their approach uses a short (6 cm) length of IEA as a Y-branch from another in situ arterial conduit or as a secondary Y-branch. Because the IEA is relatively short (mean, 11.9 ± 2.6 cm) [1] with considerable variability in its usable length from patient to patient, it is not possible to definitively plan the operation until the IEA is harvested when an aortic anastomosis is planned. Therefore, my current usage of this conduit has become that proposed by Calafiore and associates, namely as a short (4 to 8 cm) Y-branch from another arterial conduit [4]. I also believe this will achieve better patency than will direct anastomosis to the aorta because of the problems inherent in anastomosis of a small conduit to a thick-walled structure.

Footnotes

As orignally published in 1991:
1998 update

References

1. Barner H.B., Naunheim K.S., Peigh P.S., et al. Inferior epigastric artery for myocardial revascularization. Eur J Cardiothoracic Surg 1993;7:478-481.[Abstract]
2. Schroeder E., Gurné O., Chenu P. Detection of graft function and patency. In: Angelini G.D., Bryan A.J., Dion R., eds. Arterial conduits in myocardial revascularization. London: Arnold, 1996:126-130.
3. Loop F.D., Lytle B.W., Cosgrove D.M., et al. Free aortocoronary internal mammary artery grafts: late results. J Thoracic Cardiovasc Surg 1986;92:827-831.[Abstract]
4. Calafiore A.M., DiGiammario G., Luciani N., et al. Composite arterial conduits for a wider arterial myocardial revascularization. Ann Thorac Surg 1994;58:185-190.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hendrick B. Barner Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Barner, H. B. Search for Related Content PubMed PubMed Citation Articles by Barner, H. B.