title: Mid-term angiographic comparison of sequential and individual anastomosis techniques for diagonal artery.
abstract: OBJECTIVE
  The mid-term patency rates for individual and sequential grafts as coronary bypass conduits for diagonal arteries were angiographically compared; the impact of native coronary vessel and type of the conduit characteristics are investigated.
  
  
  METHODS
  Between March 1992 and April 2000, we performed a total number of 811 distal anastomosis on diagonal arteries of left anterior descending (LAD) artery in 296 patients who underwent coronary artery bypass surgery (CABG) distal anastomosis in our clinic. The patients were divided into two groups in this prospective study. In group A (n = 195) individual anastomosis technique, in group B (n = 101) sequential anastomosis technique was chosen as the myocardial revascularization strategy. At an average of 49.4 +/- 13.2 months after coronary revascularization procedure coronary angiographies were evaluated. Individual and sequential grafting techniques were compared by graft patency rates.
  
  
  RESULTS
  The patency rates of sequential conduits were markedly higher than those of individual conduits (66.7% vs. 89.2%, p = 0.0001). This difference was also clear in coronary arteries with poor quality and small (<1.5 mm) diameter (49.1% vs. 66.6%, p = 0.032). Also, the patency rates of sequential radial artery conduits were higher than sequential saphenous vein graft (SVG) conduits (sequential radial artery; 94.1%, sequential SVG; 85.3%, p = 0.043).
  
  
  CONCLUSIONS
  Sequential grafting for diagonal artery is technically more demanding but the mid-term results are better than individual grafting especially in coronary arteries with poor quality. Using radial artery as a sequential graft increases the mid-term graft patency rates.
authors.affiliation: Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
authors.forename: Bilgehan Savaş
authors.initials: BS
authors.lastname: Oz
authors.forename: Hikmet
authors.initials: H
authors.lastname: Iyem
authors.forename: Hakki Tankut
authors.initials: HT
authors.lastname: Akay
authors.forename: Cengiz
authors.initials: C
authors.lastname: Bolcal
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yokusoglu
authors.forename: Erkan
authors.initials: E
authors.lastname: Kuralay
authors.forename: Ufuk
authors.initials: U
authors.lastname: Demirkilic
authors.forename: Harun
authors.initials: H
authors.lastname: Tatar
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000637:transplantation; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000637:transplantation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation; D016896:Treatment Outcome; D014421:Turkey; D014654:Vascular Patency