Total arterial coronary bypass: long-term results.

Three groups of consecutive patients who had undergone primary elective coronary artery bypass operations were compared at 10 to 20 years of follow-up (mean, 13.6 years), in order to test the supposition that arterial conduits provide better long-term outcome than do the "standard" left internal mammary-to-left anterior descending coronary artery plus saphenous vein bypasses. The arterial group was split into groups A (all arterial) and B (2 or more arterial grafts, plus saphenous vein grafts). Control group C comprised the standard operations. The absence of saphenous vein conduit in group A was associated with fewer angiograms for symptoms, fewer reinterventions, and fewer cardiac deaths than those experienced in groups B and C. We conclude that the survival and cardiac quality-of-life advantage found in group A is attributable to the exclusive use of arterial conduits.

NONCARDIAC SURGERY COMBINED WITH CORONARY ARTERY BYPASS.

The coexistence of coronary artery disease with noncardiac disease often leads to a dilemma in planning therapeutic procedures. This problem is especially difficult in the presence of accelerated angina or left coronary artery stenosis. A series of 17 patients is presented in which coronary artery bypass grafts were combined with noncardiac operations without mortality or significant morbidity. An illustrative case report shows the interrelated nature of the coexisting disorders. The conclusion of this study is that, at times, various surgical procedures should be combined with coronary artery bypass grafting for a smoother, less complicated recovery. However, there are no hard and fast rules dictating combined procedures; each operation must be planned according to the existing conditions and needs of the individual patient.

EVERSION ENDARTERECTOMY: A NEW APPLICATION OF AN OLD TECHNIQUE.

Restoration of arterial flow to a severely ischemic extremity remains a major challenge in vascular surgery. The procedure of choice for limb salvage is a bypass utilizing reversed saphenous vein. When the saphenous vein is unsuitable or unavailable, the surgeon must turn to endarterectomy of the femoral and popliteal systems or synthetic, composite, heterologous, autologous, or homologous grafts. To avoid the problems associated with these techniques and to improve the results of limb salvage, we have revived and modified the technique of superficial femoral artery eversion endarterectomy and combined it with other reconstructive techniques in an effort to salvage the severely ischemic lower extremity. Of 38 patients treated for incapacitating claudication or severe limb ischemia during a one-year period, six patients had an unsuitable saphenous vein for the proposed reconstruction. Five of these patients underwent superficial femoral eversion endarterectomy. These six patients have 100% patency at follow-up seven months to one year postoperatively. Our experience with these six patients, including angiographic follow-up, will be presented.