Optimal patency rates obtained in coronary artery grafting with circular vein grafts

Twenty-two patients underwent coronary artery grafting with a circular vein graft comprising four or five distal coronary anastomoses. Postoperative angiographic evaluation showed patency in 90 (95.7 percent) of the 94 coronary anastomoses fashioned in this manner. All four occlusions occurred in the one patient whose graft comprised five anastomoses and was occluded beyond the first anastomosis on the right coronary artery (RCA). Eleven of the 94 anastomoses were made onto arteries with limited runoff. Blod flow averaged 214 ml. per minute (range 130 to 320) in the main portion of the graft and 59 ml. per minute (range 35 to 100) in the most distal segment. Flow doubled (averaged 403 ml. per minute) in the 11 grafts injected with papaverine. The technique of circular vein grafting is described in detail and potential pitfalls are outlined. The reasons for the high early patency rate are believed to be the following: (1) high flow in the proximal segment of the graft insuring patency of said segment, (2) termination on the left anterior descending (LAD) coronary artery providing good distal flow and patency. (3) diamond-shaped side-to-side anastomoses (SSA's) preventing angulation of the graft at these crucial points, and (4) nearly equidistant anchoring at the site of the multiple anastomoses giving the graft a smooth, even contour.