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Use of the inferior epigastric artery for coronary bypass.
J Thorac Cardiovasc Surg. 1992 Apr; 103(4):665-70.JT

Abstract

Between December 1988 and April 1991, 74 free inferior epigastric arteries were used in 73 patients for coronary artery bypass grafts. In addition, 72 of the patients received a left internal mammary artery for single or sequential grafting to the left anterior descending system and 62 a right internal mammary artery to the circumflex or the right coronary artery. Twenty-seven patients had no saphenous vein available, and two had no suitable internal mammary artery; in an attempt to make a complete arterial revascularization, we chose the inferior epigastric artery as an alternative conduit in 24 young patients and in 10 reoperations; bilateral internal mammary artery dissection was avoided in four patients with impaired lung function and in six patients with selected two-vessel disease to spare one internal mammary artery. The technique for harvesting the inferior epigastric artery is described. Fifty-three inferior epigastric artery grafts were anastomosed to the distal right coronary artery or to its branches, 18 to the distal obtuse marginals of the circumflex artery (three as sequential grafts and one as a natural Y graft), and three to the left anterior descending system. The mean number of distal anastomoses is 3.60 per patient. Seventy proximal anastomoses of the inferior epigastric artery were made to the aorta and four to one internal mammary artery. There were four early deaths and one nonfatal myocardial infarction. Four abdominal wound hematomas needed surgical drainage. Sixty-one patients underwent angiographic study on postoperative day 10:59 of 61 inferior epigastric artery grafts (63 of 65 inferior epigastric artery distal anatomoses) and 111 of 111 internal mammary artery grafts (155 of 156 internal mammary artery distal anastomoses) were patent. Clinical follow-up of all the survivors (100% follow-up) could be obtained with a mean period of 9 months (1 to 28 months). There was no late cardiac death, no infarction, and all the patients were free of angina. Nineteen patients underwent a 6-month postoperative angiographic study. Seventeen of 19 inferior epigastric artery grafts were patent and 16 of 19 were intact; 34 of 34 internal mammary artery grafts (46 of 47 internal mammary artery distal anastomoses) were patent and intact. In conclusion, free inferior epigastric artery grafts can reach the diaphragmatic ischemic areas of the heart. The early patency rate and the clinical results are encouraging but only long-term evolution and evaluation can determine the true efficacy of the inferior epigastric artery graft as a reliable conduit for coronary artery bypass graft operations.

Authors+Show Affiliations

Department of Cardiovascular and Thoracic Surgery, University of Louvain, Bruxelles.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1532220

Citation

Buche, M, et al. "Use of the Inferior Epigastric Artery for Coronary Bypass." The Journal of Thoracic and Cardiovascular Surgery, vol. 103, no. 4, 1992, pp. 665-70.
Buche M, Schoevaerdts JC, Louagie Y, et al. Use of the inferior epigastric artery for coronary bypass. J Thorac Cardiovasc Surg. 1992;103(4):665-70.
Buche, M., Schoevaerdts, J. C., Louagie, Y., Schroeder, E., Marchandise, B., Chenu, P., Dion, R., Verhelst, R., Deloos, M., & Gonzales, E. (1992). Use of the inferior epigastric artery for coronary bypass. The Journal of Thoracic and Cardiovascular Surgery, 103(4), 665-70.
Buche M, et al. Use of the Inferior Epigastric Artery for Coronary Bypass. J Thorac Cardiovasc Surg. 1992;103(4):665-70. PubMed PMID: 1532220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of the inferior epigastric artery for coronary bypass. A1 - Buche,M, AU - Schoevaerdts,J C, AU - Louagie,Y, AU - Schroeder,E, AU - Marchandise,B, AU - Chenu,P, AU - Dion,R, AU - Verhelst,R, AU - Deloos,M, AU - Gonzales,E, PY - 1992/4/1/pubmed PY - 1992/4/1/medline PY - 1992/4/1/entrez SP - 665 EP - 70 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 103 IS - 4 N2 - Between December 1988 and April 1991, 74 free inferior epigastric arteries were used in 73 patients for coronary artery bypass grafts. In addition, 72 of the patients received a left internal mammary artery for single or sequential grafting to the left anterior descending system and 62 a right internal mammary artery to the circumflex or the right coronary artery. Twenty-seven patients had no saphenous vein available, and two had no suitable internal mammary artery; in an attempt to make a complete arterial revascularization, we chose the inferior epigastric artery as an alternative conduit in 24 young patients and in 10 reoperations; bilateral internal mammary artery dissection was avoided in four patients with impaired lung function and in six patients with selected two-vessel disease to spare one internal mammary artery. The technique for harvesting the inferior epigastric artery is described. Fifty-three inferior epigastric artery grafts were anastomosed to the distal right coronary artery or to its branches, 18 to the distal obtuse marginals of the circumflex artery (three as sequential grafts and one as a natural Y graft), and three to the left anterior descending system. The mean number of distal anastomoses is 3.60 per patient. Seventy proximal anastomoses of the inferior epigastric artery were made to the aorta and four to one internal mammary artery. There were four early deaths and one nonfatal myocardial infarction. Four abdominal wound hematomas needed surgical drainage. Sixty-one patients underwent angiographic study on postoperative day 10:59 of 61 inferior epigastric artery grafts (63 of 65 inferior epigastric artery distal anatomoses) and 111 of 111 internal mammary artery grafts (155 of 156 internal mammary artery distal anastomoses) were patent. Clinical follow-up of all the survivors (100% follow-up) could be obtained with a mean period of 9 months (1 to 28 months). There was no late cardiac death, no infarction, and all the patients were free of angina. Nineteen patients underwent a 6-month postoperative angiographic study. Seventeen of 19 inferior epigastric artery grafts were patent and 16 of 19 were intact; 34 of 34 internal mammary artery grafts (46 of 47 internal mammary artery distal anastomoses) were patent and intact. In conclusion, free inferior epigastric artery grafts can reach the diaphragmatic ischemic areas of the heart. The early patency rate and the clinical results are encouraging but only long-term evolution and evaluation can determine the true efficacy of the inferior epigastric artery graft as a reliable conduit for coronary artery bypass graft operations. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/1532220/Use_of_the_inferior_epigastric_artery_for_coronary_bypass_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -