title: Endarterectomy and surgical angioplasty without cardiopulmonary bypass.
abstract: Surgical angioplasty for ostial stenosis of the major coronary arteries is a well-established treatment modality. Management of discrete stenoses of distal coronary arteries in the presence of mild proximal disease is a challenging task. Percutaneous intervention or grafting beyond the diseased segment may be limited by size of the target vessel, whereas endarterectomy followed by graft placement may result in graft occlusion due to competitive native flow. Patch angioplasty with or without endarterectomy is an effective option in this setting, which can be performed without cardiopulmonary bypass in the appropriate group of patients. A patient with triple vessel coronary artery disease and a discrete lesion in the posterior descending artery underwent off-pump endarterectomy with vein patch angioplasty in combination with bypass grafting to left anterior descending and obtuse marginal arteries. Operative technique and intraoperative strategies are discussed.
authors.affiliation: Department of Cardio-Thoracic Surgery, Apollo Heart Institute, Visakhapatnam, Andhra Pradesh, India. csaikrishna@yahoo.com
authors.forename: Cheemalapati
authors.initials: C
authors.lastname: Sai Krishna
authors.forename: Palli Venkata
authors.initials: PV
authors.lastname: Naresh Kumar
authors.forename: Vedangi
authors.initials: V
authors.lastname: Ramesh Babu
authors.forename: Kanteti
authors.initials: K
authors.lastname: Ram Mohan
mesh_terms: D000368:Aged; D017130:Angioplasty; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004691:Endarterectomy; D006801:Humans; D008297:Male