[Use of brachial venous grafts in coronary bypass surgery]

From May, 1975, to December, 1988, 30 patients (pts), 26 men and 4 women, aged 36 to 79 (average age: 58) underwent one or several aortocoronary bypass (ACB) operations requiring the use of veins from the upper limbs (VUL). Sixty operations (2.0 ACB/pt) were performed, involving the anterior interventricular artery in 27 cases, the right coronary artery in 14 and the other left vessels in 19. The grafts used were a VUL in 45 cases, an internal mammary artery in 13, a great saphenous vein in one case and a 4-mm polyurethan tube in one case. The indications for the use of a VUL included bilateral stripping in 23 patients, repeated phlebitis in one, bilateral varices in 2, and the previous use of the saphenous veins in 4 patients. The coronary lesions were a three-vessel involvement in 17 cases, a two-vessel involvement in 9 and a single-vessel involvement in 4. An additional procedure was required in two patients for the resection of a left ventricular aneurysm and for the plication of an akinetic area of the left ventricle. No intraoperative complication was observed. Perioperative mortality was of two cases (6.6%). The postoperative myocardial infarction rate was of one case (3.3%). A complication directly associated with the type of graft used (massive bleeding due to graft tearing) caused cardiac arrest in one case. Two patients presented with local disorders caused by the removal of veins from the upper limbs, including hypoesthesia of the forearm in one case and anesthesia associated with regressive muscle enfeeblement in the other.(ABSTRACT TRUNCATED AT 250 WORDS)