Coronary artery bypass grafting with the inferior epigastric artery: Midterm clinical and angiographic results

Abstract

Between December 1988 and September 1993, 157 patients (141 men, 16 women, average age 60.2 years, range 37 to 78 years) underwent a complete myocardial revascularization with 157 inferior epigastric artery grafts and 285 internal mammary artery grafts (281 in situ, 4 free grafts). A total of 543 distal arterial anastomoses (average 3.4, range two to five per patient) were constructed, 376 with the internal mammary artery and 167 with the inferior epigastric artery. The inferior epigastric artery grafts were anastomosed to two left anterior descending, 5 diagonal, 34 circumflex, and 126 right coronary arteries. The indications for the use of the inferior epigastric artery were the unavailability of conventional conduits in 56 patients and a favorable anatomy or a young age in 101 selected patients. The clinical follow-up averages 31.8 months (range 6 to 62 months). Four patients died early, and there were three perioperative nonfatal myocardial infarctions. Eight patients required early reoperation for thoracic bleeding (2) or drainage of an abdominal parietal collection (6). There were four late deaths (2 sudden deaths, 2 noncardiac causes) and one nonfatal myocardial infarction. Angina recurred in nine patients, of whom one required reoperation and three underwent successful percutaneous balloon angioplasty of a native coronary artery (2) or an old saphenous vein graft (1). An early recatheterization was obtained before discharge (average 11 days) in 135 patients: 132 of 135 inferior epigastric artery grafts were patent. Seventy-seven patients underwent a second angiographic restudy 6 to 43 months after the operation. Forty-four of the 48 inferior epigastric artery grafts restudied within the first postoperative year (average 8.5 months) were patent, but eight showed a diffuse narrowing. Twenty-eight of the 29 inferior epigastric artery grafts examined angiographically between 13 and 43 months (average 25 months) were open, and among those 29, 25 were widely patent, perfectly matching the receiving coronary artery. Most of the occluded or narrowed inferior epigastric artery grafts were grafted onto coronary arteries with mild stenosis at restudy. Five patients underwent a third angiographic reexamination up to 60 months after the operation (average 39 months). All five inferior epigastric artery grafts were widely patent. The early attrition rate of the inferior epigastric artery, as for any free arterial graft, is probably the result of both the loss of a true pedicle and the need for constructing an additional proximal anastomosis. The fact that the patency rate of the inferior epigastric artery graft seems to remain stable beyond 1 year could suggest a good durability in the future.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…Because it is a muscular artery, it is prone to spasm and therefore is best used to bypass a severely stenotic coronary artery. Its reported 1-year patency is about 90% (133,134).…”

Is it better to use the radial artery as a composite graft? Clinical and angiographic results of aorto-coronary versus Y-graft1

“…This allowed us to work in a more comfortable surgical field and to obtain a perfect RA and left ITA graft length between the Y-anastomosis and their first coronary target, avoiding both the risk of kinking of the grafts and traction on the coronaries. On the contrary RA anastomosis to the ascending aorta is quite simple because the thick vessel wall and the large diameter make the management of this graft easy, avoiding the technical problems related to anastomosis between a thin-walled vessel and a thicker aortic wall, which may produce stenosis and thrombosis of arterial grafts like the right ITA [11,12], the inferior epigastric artery [13] and the gastroepiploic artery [14]. The favorable anatomic characteristics of the RA explain our choice to perform sequential diamond anastomoses in both groups of patients in presence of two or more distal targets.…”

Conduits for Coronary Bypass: Arteries Other Than the Internal Thoracic Artery's

“…Use is limited by length which is adequate for the LAD, marginal, and sometimes the posterior descending artery. Thus the contribution by Calafiore is valuable as it solves the proximal anastomosis problem and also length issues by adding approximately 10 cm to the effective length of the IEA [9,65]. Another option is end-to-end anastomosis to an in situ ITA to reach more distal targets or two IEA's may be linked to create a longer graft.…”

“…Buche et al [65] reported 92% (44/48) patency at 8.5 months and 97% (28/29) at 25 months. Puig et al [61] achieved 87.5% (14/16) patency at a mean of 81.2 months.…”