"Hexatuple" coronary bypass with in situ arterial grafts

A fifty-seven year old male patient with severe three-vessel coronary artery disease underwent successful coronary bypass surgery in six vessels utilizing the in situ left internal thoracic and right gastroepiploic arteries. Each arterial conduit was anastomosed sequentially to as many as three coronary vessels respectively. Surgical results were excellent and the patient continues to do very well. A postoperative angiogram showed well-working arterial conduits without any anastomotic problems. Multiple sequential anastomoses of the in situ arterial conduits, although rather technically demanding, can provide better long-term results in patients requiring multiple coronary revascularization. When sequential anastomoses of the right gastroepiploic artery are being considered, the length and caliber of the artery should be evaluated by an angiogram since it varies in size compared to the internal thoracic artery.