Ann Thorac Surg 2008;85:e23. doi:10.1016/j.athoracsur.2008.01.069
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
30-Year Patency of a Saphenous Vein Graft in Coronary Bypass Graft Surgery
Ali Vefa Ozcan, MDb,*,
Harun Evrengul, MDa,
Ibrahim Goksin, MDb,
Sukru Gur, MDa,
Asuman Kaftan, MDa
a Department of Cardiology, Pamukkale University, Denizli, Kinikli, Turkey
b Department of Cardiovascular Surgery, Pamukkale University, Denizli, Kinikli, Turkey
* Address correspondence to Dr Ozcan, Pamukkale University, Faculty of Medicine, Department of Cardiovascular Surgery, Siteler Mahallesi. Barbaros Cad. 6248 Sokak, C-Blok, No 3, Denizli, Kinikli, 20070, Turkey (Email: vefaozcan{at}yahoo.com).
A 74-year-old man was admitted to our institute complaining of angina pectoris. Electrocardiography revealed sinus rhythm with left bundle branch block. He had a 30-year history of acetylsalicylic acid use.
Thirty years previously, an anastomosis had been created between the ascending aorta and the left anterior descending artery (LAD) using a saphenous vein graft. Angiography showed significant lesions in the right coronary and circumflex coronary arteries. The proximal LAD artery was completely occluded, but the previously performed aorto-LAD bypass was working perfectly (Fig 1A, Angiographic image; B, diameters of vessels. 1 = saphenous vein graft; 2 = the proximal LAD; 3 = the distal LAD; 4 = 6F Judkins catheter; * = proximal anastomosis; ** = distal anastomosis). The right coronary artery and circumflex lesions were successfully treated with stents.
The best predictor of the graft patency is the diameter of the vessel. For saphenous vein grafts performed to the LAD, the 10-year patency is 90% for vessels exceeding 2.0 mm compared with 52% for vessels of 2.0 mm or less [1]. In this patient, the diameter of LAD measured 2.5 mm in the anastomotic region (Fig 1B).
The first saphenous vein graft was used in coronary artery bypass graft (CABG) surgery by Favaloro in 1967 [2]. There are little data on the longest patency of saphenous vein grafts, but a patency of 19-year coronary-coronary venous graft bypass [3] has been reported. This report presents a 30-year patency of a saphenous vein graft in CABG surgery. This is a very noteworthy case considering the 40-year history of CABG.
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References
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- Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study J Am Coll Cardiol 2004;44:2149-2156.[Abstract/Free Full Text]
- Kirklin JW, Barratt-Boyes BG. Cardiac surgeryIn: Kirklin JW, Barrat-Boyes BG, editors. Ischemic heart disease. 3rd ed.. New York, NY: Churchill Livingstone; 2003. pp. 353-435.
- Mariscalco G, Blanzola C, Leva C, Bruno VD, Luvini M, Sala A. 19-year patency of a coronary-coronary venous bypass graft Tex Heart Inst J 2005;32:583-585.[Medline]
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