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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


ARTICLES

Comparative anatomic studies of various arterial conduits for myocardial revascularization

JA van Son, F Smedts, JG Vincent, HJ van Lier and K Kubat
Department of Thoracic and Cardiac Surgery, Academic Hospital Nijmegen, The Netherlands.

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.


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CirculationHome page
D. G. Cable, J. A. Caccitolo, N. Caplice, T. O’Brien, R. D. Simari, R. C. Daly, J. A. Dearani, C. J. Mullany, T. A. Orszulak, and H. V. Schaff
The Role of Gene Therapy for Intimal Hyperplasia of Bypass Grafts
Circulation, November 9, 1999; 100 (2009): II-392 - II-396.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al.
ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)
J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347.
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HeartHome page
D P TAGGART
The radial artery as a conduit for coronary artery bypass grafting
Heart, October 1, 1999; 82(4): 409 - 410.
[Full Text] [PDF]


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HeartHome page
O Gurne, P Chenu, M Buche, Y Louagie, P Eucher, B Marchandise, E Rombaut, D Blommaert, and E Schroeder
Adaptive mechanisms of arterial and venous coronary bypass grafts to an increase in flow demand
Heart, September 1, 1999; 82(3): 336 - 342.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
O. Simic, M. Zambelli, M. Zelic, and A. Pirjavec
Thoracodorsal artery as a free graft for coronary artery bypass grafting
Eur. J. Cardiothorac. Surg., July 1, 1999; 16(1): 94 - 96.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
T. Sasajima, V. Bhattacharya, M. Hong-De Wu, Q. Shi, N. Hayashida, and L. R. Sauvage
Morphology and histology of human and canine internal thoracic arteries
Ann. Thorac. Surg., July 1, 1999; 68(1): 143 - 148.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
A. Bhan, V. Gupta, S. K. Choudhary, R. Sharma, B. Singh, R. Aggarwal, B. Bhargava, A. V. Sharma, and P. Venugopal
Radial artery in CABG: could the early results be comparable to internal mammary artery graft?
Ann. Thorac. Surg., June 1, 1999; 67(6): 1631 - 1636.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
Y. Ichikawa, H. Kajiwara, T. Hamada, I. Yamazaki, Y. Jin, and S. Sato
Late vasospasm of the inferior epigastric artery graft
Ann. Thorac. Surg., June 1, 1999; 67(6): 1800 - 1801.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
J. A.M. van Son
Use of radial artery as coronary bypass graft in myocardial revascularization
Ann. Thorac. Surg., June 1, 1999; 67(6): 1825 - 1826.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
T. Tashiro, K. Nakamura, A. Iwakuma, R. Zaitu, H. Iwahashi, A. Murai, and M. Kimura
Inverted T graft: novel technique using composite radial and internal thoracic arteries
Ann. Thorac. Surg., March 1, 1999; 67(3): 629 - 631.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
F. L. Rosenfeldt, G.-W. He, B. F. Buxton, and J. A. Angus
Pharmacology of coronary artery bypass grafts
Ann. Thorac. Surg., March 1, 1999; 67(3): 878 - 888.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
G.-W. He
Arterial grafts for coronary artery bypass grafting: biological characteristics, functional classification, and clinical choice
Ann. Thorac. Surg., January 1, 1999; 67(1): 277 - 284.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
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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J. Thorac. Cardiovasc. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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J. Thorac. Cardiovasc. Surg.Home page
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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J. Thorac. Cardiovasc. Surg.Home page
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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VASC ENDOVASCULAR SURGHome page
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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Cardiovasc ResHome page
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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Cardiovasc ResHome page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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J. Thorac. Cardiovasc. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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J. Thorac. Cardiovasc. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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J. Thorac. Cardiovasc. Surg.Home page
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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Ann. Thorac. Surg.Home page
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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VASC ENDOVASCULAR SURGHome page
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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