Vein Patch Reconstruction and Endarterectomy Combined with IMA Grafting in Left Anterior Descending Coronary Artery Lesions

Between February 1985 and March 1990 IMA anastomosis was performed on saphenous vein patch reconstruction in 42 patients who had long segmental narrowings and occlusions in the LAD artery. In 27 of them open and blind endarterectomy were added to these procedures. The morbidity in terms of requirement for inotropic agents, IABP, development of perioperative myoardial infarction (14 %) and the mortality (9.5 %, 4 patients) were found significantly higher than routine coronary revascularization operations. These cases carry high risks due to poor left ventricular function, reoperation, unstable angina multivessel disease. Although the mortality and morbidity are high, such combined techniques can be used to obtain complete revascularization under certain warranted conditions. Especialls in proximal LAD, blind endarterectomy should be avoided as it is possible to obtain sufficient luminal width and use IMA by saphenous vein patch reconstruction without endarterectomy.