Technique for use of the inferior epigastric artery as a coronary bypass graft

A search for a coronary bypass conduit with increased longevity has resulted in harvest of the inferior epigastric artery. The artery is dissected through a paramedian incision with retraction of the rectus muscle to the lateral side. As the inferior epigastric artery courses superiorly, it may lie in one of three positions in relation to the rectus muscle. Distal coronary anastomoses using this conduit are conventional, and the proximal anastomosis may be made to the aorta or end-to-side to an internal mammary artery or venous conduit. After preparation with dilute papaverine-Plasmalyte solution proximal sizes have ranged from 2.5 to 3.25 mm (internal diameter), and distal inferior epigastric artery sizes measured 1.5 to 2.5 mm (internal diameter). The lengths of the conduit ranged from 11.5 to 17.0 cm. Eighteen patients aged 41 to 74 years had inferior epigastric artery grafts to 19 coronary arteries. The indications for use were absent or poor-quality vein, young age with an attempt to limit vein graft, and avoidance of use of bilateral internal mammary artery grafts in insulin-dependent diabetic patients. There was one sterile wound hematoma and one late wound infection. There were no other infections and no deaths. Three patients studied postoperatively revealed widely patent inferior epigastric artery grafts.