Experience with arm veins as aorto-coronary bypass grafts

In a series of 1,000 coronary bypass operations 15 patients received arm vein grafts. In these cases the saphenous veins were either absent or inadequate and the mammary arteries alone were not sufficient for multivessel coronary revascularization. Altogether, 34 coronary anastomoses were performed with 16 arm vein grafts; additional coronary endarterectomy was needed in four instances. Together with mammary artery or saphenous vein grafts these patients each had, on the average, 3.6 coronary anastomoses. There was no operative mortality and no complication related to the arm vein grafts. Postoperatively all the patients were free of angina pectoris. A follow-up angiogram (mean 1.4 years postoperatively) showed a patency rate of 87% for arm vein grafts. A frequent finding was an uneven diameter of the grafts. In three patients aneurysmal dilatation (of 8.3 to 9.8 mm in diameter) was revealed. Although the patency rate to date is satisfactory, our experience is too limited in time numbers to judge long term durability.