title: Increased graft occlusion or string sign in composite arterial grafting for mildly stenosed target vessels.
abstract: BACKGROUND
  Composite grafting is a useful technique that avoids the need for aortic manipulation and enables a wide range of target vessels to be revascularized, effectively using the limited arterial grafts available. However, it has not been clarified whether composite grafting can achieve angiographic outcomes equivalent to those obtained with individual grafting for specific target vessels.
  
  
  METHODS
  We retrospectively reviewed 830 distal arterial graft anastomoses in 256 patients who underwent off-pump coronary artery bypass surgery and also underwent 1-year follow-up coronary angiograms. Four hundred and ten anastomoses using a composite grafting technique were compared with 420 anastomoses using individual grafting.
  
  
  RESULTS
  In target vessels with mild stenosis, the incidence of graft occlusion or string sign was significantly higher in composite internal thoracic arteries (ITA) than in individual ITA grafts (composite 20.3% versus individual 7.3%; p = 0.018) and showed a higher tendency in composite radial arteries (RA) than in individual RA grafts (59.3% versus 36.4%, p = 0.09). In contrast, the incidence was similar between composite and individual ITA grafts (5.7% versus 3.3%, p = 0.278) and composite and individual RA grafts (11.5% versus 29.6%, p = 0.297) in target vessels with severe stenosis.
  
  
  CONCLUSIONS
  The angiographic outcomes of composite grafts were closely related to the severity of stenosis of the target coronary artery. In target vessels with mild stenosis, composite grafting resulted in a higher incidence of graft occlusion or string sign than individual grafting did.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. s-manabe@fb3.so-net.ne.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Manabe
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Katayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000473:pathology / Q000601:surgery; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D017534:Radial Artery / Q000637:transplantation