The inferior epigastric artery for coronary bypass grafting. Functional assessment and clinical results.
The use of the internal thoracic artery (ITA) for coronary bypass grafting (CBG) has resulted in superior long-term function. Other autologous arteries have been investigated also, but the role of the inferior epigastric artery (IEA) for CBG has not yet been defined. From March 91 to August 92, IEA grafts were used in 50 male patients aged 30-68 years/mean 54.9) combined with 1 (n = 40) or 2 (n = 8) ITA grafts. Pedicled grafts were dissected (length: 8.5-16.5, 13.1 cm) but left in situ covered by sponges soaked with papaverine solution until going on bypass. There was no mechanical or pharmacological intraluminal manipulation. Distal free flow (in situ) was 41.8 ml/min (16-95 ml/min). A total of 146 grafts were constructed (2.9/patient), including free IEA-CBG performed to the LAD (n = 28) or its diagonal branches (n = 22). The operative mortality was 2.0%, there were no sternal wound complications but superficial abdominal infections in 5 patients. Recatheterization (1-6 months postoperatively) revealed an 82.6% patency rate (19/23) in IEA, compared to 100% in ITA, grafts. In vitro stimulation of arterial segments by endothelium- or muscular-dependent relaxation revealed a response (% of the maximum) of 92.4% in IEA and 74.6% in ITA to acethylcholine, while the response to nitroglycerin was 92.7% and 98.6%, respectively. Our clinical results would support the concept of combining IEA and ITA for arterial revascularization in CBG. Inferior epigastric artery grafts should provide adequate blood flow and good long-term patency due to preservation of their endothelial function.
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
J
J
Cremer
A
A
Mügge
M
M
Schulze
H J
HJ
Trappe
M
M
Schneider
B
B
Heublein
A
A
Haverich
D000009:Abdominal Muscles / Q000098:blood supply*; D000328:Adult; D000368:Aged; D001158:Arteries / Q000637:transplantation; D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D011183:Postoperative Complications; D014654:Vascular Patency