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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 703-707, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JA van Son, F Smedts, JG Vincent, HJ van Lier and K Kubat
Comparison was made between the morphologic condition of the left anterior
descending artery and four arterial conduits: the internal mammary, right
gastroepiploic, inferior epigastric, and radial arteries, harvested from 17
patients (aged 15 to 85 years, mean 64 years) who had died of nonvascular
diseases. Proximal, mid, and distal segments were examined microscopically.
The internal mammary artery was elastic, but the others were muscular. In
all four conduits, atherosclerosis was absent to mild, the internal elastic
lamina showed only minimal defects, and the vasa vasorum were confined to
the adventitia. In all cases the left anterior descending artery showed
mild to severe atherosclerosis and substantial defects in the internal
elastic lamina with penetration of the vasa vasorum into the media and
intima. Comparison of the mean distance (+/- standard deviation) from the
lumen to the outermost portion of the media for the left anterior
descending artery (320 +/- 63 microns) with the four conduits gave
comparable values for the internal mammary artery (350 +/- 92 microns); p =
not significant) and the right gastroepiploic artery (291 +/- 109 microns;
p = not significant), versus 529 +/- 52 microns; p less than 0.002) for the
radial artery and 249 microns (+/- 87 microns) (p less than 0.04) for the
inferior epigastric artery (Kruskal-Wallis and Mann- Whitney U tests). The
relatively scanty presence of smooth muscle cells in the thin-walled media
of the internal mammary artery combined with a well-formed internal elastic
lamina, even at advanced age, may be an important cause for its low
susceptibility to atherosclerosis and a major determinant in its superior
long-term patency as a coronary artery bypass graft. This finding
emphasizes the justification of continued use of the ideally matching
internal mammary artery, either as in situ or free graft, in coronary
artery bypass grafting. In contrast to the thick-walled radial artery,
which may be relatively prone to ischemia, an acceptable long-term patency
of the inferior epigastric artery and right gastroepiploic artery, if
harvested as pedicled grafts, is anticipated.
ARTICLES
Comparative anatomic studies of various arterial conduits for myocardial revascularization
Department of Thoracic and Cardiac Surgery, Academic Hospital Nijmegen, The Netherlands.
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F. D. Loop Coronary artery surgery: the end of the beginning Eur. J. Cardiothorac. Surg., December 1, 1998; 14(6): 554 - 571. [Abstract] [Full Text] [PDF] |
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C. Acar, A. Ramsheyi, J.-Y. Pagny, V. Jebara, P. Barrier, J.-N. Fabiani, A. Deloche, J.-L. Guermonprez, and A. Carpentier THE RADIAL ARTERY FOR CORONARY ARTERY BYPASS GRAFTING: CLINICAL AND ANGIOGRAPHIC RESULTS AT FIVE YEARS J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 981 - 989. [Abstract] [Full Text] [PDF] |
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A. H. Chester, A. J. Marchbank, J. A.A. Borland, M. H. Yacoub, and D. P. Taggart Comparison of the morphologic and vascular reactivity of the proximal and distal radial artery Ann. Thorac. Surg., December 1, 1998; 66(6): 1972 - 1976. [Abstract] [Full Text] [PDF] |
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P. Gagliardotto, P. Coste, M. Lazreg, and V. Dor Skeletonized right gastroepiploic artery used for coronary artery bypass grafting Ann. Thorac. Surg., July 1, 1998; 66(1): 240 - 242. [Abstract] [Full Text] [PDF] |
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T. Tashiro, K. Nakamura, S. Sukehiro, M. Nakamura, R. Shibano, T. Motomura, and M. Kimura Midterm Results of Free Internal Thoracic Artery Grafting for Myocardial Revascularization Ann. Thorac. Surg., April 1, 1998; 65(4): 951 - 954. [Abstract] [Full Text] [PDF] |
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T. Sasajima, M. H.-D. Wu, Q. Shi, N. Hayashida, and L. R. Sauvage Effect of Skeletonizing Dissection on the Internal Thoracic Artery Ann. Thorac. Surg., April 1, 1998; 65(4): 1009 - 1013. [Abstract] [Full Text] [PDF] |
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W. E. Cohn, H. C. Suen, R. M. Weintraub, and R. G. Johnson The "H" graft: An alternative approach for performing minimally invasive direct coronary artery bypass J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 148 - 151. [Abstract] [Full Text] [PDF] |
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E. E. Weinschelbaum, E. D. Gabe, A. Macchia, R. Smimmo, and L. D. Suarez TOTAL MYOCARDIAL REVASCULARIZATION WITH ARTERIAL CONDUITS: RADIAL ARTERY COMBINED WITH INTERNAL THORACIC ARTERIES J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 911 - 916. [Abstract] [Full Text] |
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M. Ferro, M. Forni, R. Crivello, D. Palladin, M. Conti, and G. Palestro Histologic Evidence Suggesting That the Right Gastroepiploic Artery is Less Suitable and Less Long Lasting Than the Internal Mammary if Used as a Bypass Conduit: A Post-Mortem Comparison of the Gastroepiploic, Internal Mammary, Left Coronary, and Renal Arteries in Unselected Subjects Vascular and Endovascular Surgery, September 1, 1997; 31(5): 671 - 677. [Abstract] [PDF] |
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P. B. Canham, H. M. Finlay, and D. R. Boughner Contrasting structure of the saphenous vein and internal mammary artery used as coronary bypass vessels Cardiovasc Res, June 1, 1997; 34(3): 557 - 567. [Abstract] [Full Text] [PDF] |
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A. A. Voors, M. Oosterga, H. Buikema, J. F. May, J. G. Grandjean, A. van Buiten, and W. H. van Gilst Dyslipidemia and endothelium-dependent relaxation in internal mammary arteries used for coronary bypass surgery Cardiovasc Res, June 1, 1997; 34(3): 568 - 574. [Abstract] [Full Text] [PDF] |
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G.-W. He and C.-Q. Yang Radial Artery Has Higher Receptor-Mediated Contractility but Similar Endothelial Function Compared With Mammary Artery Ann. Thorac. Surg., May 1, 1997; 63(5): 1346 - 1352. [Abstract] [Full Text] |
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E. Kaufer, S. M. Factor, R. Frame, and R. F. Brodman Pathology of the Radial and Internal Thoracic Arteries Used as Coronary Artery Bypass Grafts Ann. Thorac. Surg., April 1, 1997; 63(4): 1118 - 1122. [Abstract] [Full Text] |
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J. A. M. van Son, V. Falk, T. Walther, F. M. Smedts, and F. W. Mohr Low-Grade Intimal Hyperplasia in Internal Mammary and Right Gastroepiploic Arteries as Bypass Grafts Ann. Thorac. Surg., March 1, 1997; 63(3): 706 - 708. [Abstract] [Full Text] |
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J. A. M. van Son, F. M. Smedts, C.-Q. Yang, M. Mravunac, V. Falk, F. W. Mohr, and G.-W. He Morphometric Study of the Right Gastroepiploic and Inferior Epigastric Arteries Ann. Thorac. Surg., March 1, 1997; 63(3): 709 - 715. [Abstract] [Full Text] |
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O. Yildiz, S. Cicek, I. Ay, U. Demirkilic, and M. Tuncer Hypertension Increases the Contractions to Sumatriptan in the Human Internal Mammary Artery Ann. Thorac. Surg., November 1, 1996; 62(5): 1392 - 1395. [Abstract] [Full Text] |
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R. Nottin, J. M. Grinda, S. Anidjar, T. Folliguet, M. Detroux, and S. C. Planche CORONARY-CORONARY BYPASS GRAFT: AN ARTERIAL CONDUIT-SPARING PROCEDURE J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1223 - 1230. [Abstract] [Full Text] |
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F. D. A. d. Costa, I. A. d. Costa, R. Poffo, D. Abuchaim, R. Gaspar, L. Garcia, and D. L. Faraco Myocardial Revascularization With the Radial Artery: A Clinical and Angiographic Study Ann. Thorac. Surg., August 1, 1996; 62(2): 475 - 479. [Abstract] [Full Text] |
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B. L. Robinson, T. Morita, K. Fujita, M. Chow, H. V. Schaff, and J. J. Morris BYPASS CONDUIT VESSEL WALL BIOLOGY SUBSTANTIALLY INFLUENCES DOWNSTREAM MYOCARDIAL CONTRACTILE RESPONSE TO INJURY FROM ISCHEMIA AND REPERFUSION J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 62 - 73. [Abstract] [Full Text] |
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R. Malhotra, H. S. Bedi, S. Bazaz, S. Jain, and N. Trehan Morphometric Analysis of the Right Gastroepiploic Artery and the Internal Mammary Artery Ann. Thorac. Surg., January 1, 1996; 61(1): 124 - 127. [Abstract] [Full Text] |
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T. Carrel, F. W. Ammann, J. Schneider, H. Domeisen, and M. Turina ATHEROSCLEROTIC LESIONS OF THE GASTROEPIPLOIC ARTERY: ONE CASE REQUIRING POSTOPERATIVE DILATION AND SOME INTERESTING POSTMORTEM OBSERVATIONS J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1768 - 1770. [Full Text] |
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A. M. Calafiore, G. Di Giammarco, G. Teodori, E. D'Annunzio, G. Vitolla, C. Fino, and N. Maddestra Radial Artery and Inferior Epigastric Artery in Composite Grafts: Improved Midterm Angiographic Results Ann. Thorac. Surg., September 1, 1995; 60(3): 517 - 523. [Abstract] [Full Text] |
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M. Ferro, M. Forni, D. Palladin, R. Crivello, M. Conti, and G. Palestro Mammary Artery: Difference in Structure Since Birth as Compared with Coronary and Renal Artery Vascular and Endovascular Surgery, September 1, 1995; 29(5): 365 - 369. [Abstract] [PDF] |
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