A single aorto-coronary venous bypass grafting procedure attaching a vein e
nd-to-end to the proximal right coronary artery was first performed by Fava
loro in Cleveland.(1,2) Complex distal venous bypasses from the aorta to th
e side of the coronary vessels were first used by Johnson(3-6) in Milwaukee
. These two developments contributed the most to the development of modern
revascularization operations which are now the most frequent surgical inter
ventions in the world. Coronary artery bypass surgery, and later coronary a
ngioplasty, significantly improved the results of the treatment of patients
with coronary artery disease, reducing mortality and improving the quality
of life. However, the efficacy of both methods of treatment for advanced c
oronary artery disease is limited. In patients with diffuse distal disease,
it is impossible to perform balloon angioplasty, stent implantation, or by
pass grafting. Endarterectomy over a portion of or over all of a coronary s
ystem is an alternative approach, but this carries measurably increased ris
k over the other therapies; with extension of atherosclerosis into the 3rd
and 4th branches of arteries, or with obliteration of arteries after failed
grafts, endarterectomy is not possible. There is a significant restenosis
rate after all coronary interventions, some sooner, some later.