Complementary saphenous grafting: Long-term follow-up

Objective: Recently we reviewed the 10-year clinical and angiographic outco mes of sequential internal thoracic artery grafting. Most of the patients a lso received complementary saphenous grafts, and their overall long-term pa tency rates were surprisingly high. Therefore, we decided to analyze these results in more detail. Methods: The first consecutive 500 patients having received at least one se quential internal thoracic artery graft between October 1985 and August 199 1 were restudied retrospectively. The saphenous grafts were only used to ac hieve complete revascularization in addition to complex arterial grafting o n less significant or remote coronary vessels. A total of 161 patients cons ented to a late angiographic restudy at a mean postoperative interval of 7. 5 years (1-12.2 years). Results: At 5 and 10 years postoperatively, freedom from angina was 96% and 82%, and freedom from any cardiac event was 92.8% and 69%, respectively. O nly 15 (3.1%) patients needed additional revascularization. (0.3% per patie nt-year): 4 coronary artery bypass grafting (0.8%) and 11 percutaneous tran sluminal coronary angioplasty (2.3%). The overall patency and intactness ra tes of saphenous anastomoses were 72.5% and 60.2%, respectively. There was a significant difference between the patency and intactness of sequential v ersus single anastomoses: 76% versus 60% and 64.5% versus 44.4%, respective ly. There was no significant difference in either patency or intactness bet ween right internal thoracic and Sequential saphenous grafts anastomosed to the right coronary artery: 83.4% versus 75.2% and 77.8% versus 62.4%, resp ectively. The same was true for the anastomoses to the "remote area" (dista l circumflex, distal right coronary artery). Conclusions: Complementary sequential saphenous grafting still deserves con sideration in some patients below 70 years of age, particularly for those w ith disease in the "remote area": the distal circumflex and right coronary branches.