Editorials Total arterial revascularisation seems promising

Is one arterial graft enough?

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7089.1213 (Published 26 April 1997) Cite this as: BMJ 1997;314:1213
  1. Malcolm Underwood, Clinical fellowa,
  2. Graham Cooper, Consultant cardiothoracic surgeonb,
  3. Bruce Keogh, Consultant cardiothoracic surgeonc
  1. a Service de Chirurgie Cardiovasculaire et Thoracique, Universite Catholique de Louvain, avenue Hippocrate 10, B-1200 Bruxelles, Belgium
  2. b Department of Cardiac Surgery, Northern General Hospital, Sheffield S5 7AU
  3. c Department of Cardiac Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH

    The natural course of coronary revascularisation with saphenous vein grafts is well documented. Within 10 years half will have become blocked by a combination of thrombosis, intimal hyperplasia, and atherosclerosis.1 Since the long term benefit largely depends on the grafts remaining patent, arterial grafts are being used increasingly in the hope that they will remain patent for longer and so give better long term results.

    The concept of using arterial grafts is not new. Vineberg used the mammary artery for his pioneering procedure in the 1950s,2 and reports of the left internal mammary artery being used as a direct coronary graft appeared in the late 1960s.3 Histological and functional studies have shown that the internal mammary artery has biological properties that help it to resist thrombosis, intimal hyperplasia, and atherosclerosis,4 5 suggesting that it may have better patency than saphenous vein. These hopes are borne out in practice. Left internal mammary artery grafts to the left anterior descending coronary artery have given consistently better patency rates than saphenous vein grafts.6 Retrospective clinical reviews and registry …

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