A MODIFIED RECONSTRUCTION TECHNIQUE AFTER EXTENDED ANTERIOR DESCENDING ARTERY ENDARTERECTOMY

An increasing number of patients with advanced coronary artery disease and diffusely complex atherosclerotic lesions are referred for corona ry artery bypass surgery (CABG). Under these circumstances, complete m yocardial revascularization with an adequate distal runoff can only be achieved by extensive manual endarterectomy and a reconstructive proc edure prior to conduit placement. Because of the numerous septal and d iagonal branches of the left anterior descending artery (LAD), an exte nded and meticulous endarterectomy is warranted. Placement of the inte rnal mammary artery (IMA) on such a widely opened vessel requires reco nstruction with a vein patch and the IMA. A modified technique of exte nded manual endarterectomy, distal vein patch, and proximal IMA recons truction and revascularization is described. This technique was used i n six patients between October 1990 and December 1992 with 100% early survival. This technique is less time consuming and more importantly a llows for a direct artery-to-artery anastomosis with the potential for a better long-term patency.