title: Tandem pedicled internal thoracic artery conduit for sequential grafting of multiple left anterior descending coronary artery lesions.
abstract: A patient presented with severe triple-vessel coronary artery disease, including multiple lesions on the left anterior descending coronary artery (LAD), which supplied a well-contracting myocardium. In approaching our patient, we judged that a pedicled left internal thoracic artery (LITA) would not provide enough length for sequential grafting of the multisegment-diseased LAD. We also considered that a pedicled right internal thoracic artery (RITA) conduit would not be long enough to provide a free segment that would form a tandem graft with a LITA and then arrive at the marginal branch, unless it was detached at its origin. Consequently, we decided to form a composite graft that would connect a free, short segment (6-7 cm) of pedicled LITA to the in situ pedicled RITA, in an end-to-end fashion. This new composite conduit enabled us to perform sequential grafting (3 sequential anastomoses, 2 with the LITA segment) of the multisegment-diseased LAD, following the route anterior to the aorta. The in situ remnant of the LITA was grafted to the marginal branch. Although many large series have reported resourceful solutions, to the best of our knowledge, tandem arterial sequential grafting (an in situ pedicled RITA plus a free, short segment of a pedicled LITA) has not heretofore been reported in application to the multisegmented-diseased LAD artery. We strongly believe that this technique is an attractive variation on bilateral pedicled ITA left-sided revascularization in cases of multivessel coronary artery disease, including LADs with multiple lesions.
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia. nezic@EUnet.yu
authors.forename: Dusko
authors.initials: D
authors.lastname: Nezic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Knezevic
authors.forename: Predrag
authors.initials: P
authors.lastname: Milojevic
authors.forename: Miomir
authors.initials: M
authors.lastname: Jovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Sagic
authors.forename: Bosko
authors.initials: B
authors.lastname: Djukanovic
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013895:Thoracic Arteries / Q000601:surgery