[Y-grafting using the inferior epigastric artery for coronary revascularization]

On view of the remarkable good results obtained with arterial grafts for coronary revascularization, the authors continue to conduct the total arterial bypass grafting. However, the following disadvantages are encountered; 1) arterial graft crossing over the aorta and 2) left internal thoracic artery (LITA) is on some occasions impossible to anastomose with the left anterior descending (LAD) coronary artery. To eliminate these problems, "IEA Y-grafting" which the IEA is anastomosed with the LITA in an end-to-side fashion was conducted. From January to December 1994, 24 patients underwent coronary revascularization by this method. All 24 IEA grafts were anastomosed to the circumflex coronary artery (22), right coronary artery (3) or diagonal branch. (1). LITA graft were used on 24 patients (29 anastomosis) with the right gastro-epiploic artery (RGEA) at 16 (17) and RITA at 2. Immediate postoperative angiographic evaluation of the IEA grafts indicated 17 anastomoses to be patent (17/19, 89.5%). Two patients died due to coronary spasm. Although hypoperfusion poses a serious problem in this method, IEA may be considered to serve as a 3rd alternative for an arterial conduit.