Cor Vasa 2004, 45(9):418-421

Surgical revascularization in patients with shortage of suitable vein grafts on the lower extremities

Petr Němec^*, Vilém Bruk, Marek Gwozdziewicz, Andrea Steriovský, Petr Vymětal, Roman Hájek

Kardiochirurgická klinika, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Karlovy, Olomouc, Česká republika

Aim:
To assess the risk of revascularization with multiple arterial grafts in elderly patients with multiple risk factors.

Patients and methods:
A shortage of vein grafts on the lower extremities was found in 32 patients (aged 72.7 ± 5.5 years), who were listed for myocardial revascularization. The reasons for vein shortage were inferior quality in 21 patients (mostly because of varicose veins), absence of suitable vein grafts at all (9 patients had surgery for varicose veins) and fear of inappropriate wound healing (one patient suffered from leg ischemia and another one from the post-thrombotic syndrome).

Results:
The left internal thoracic artery was used for revascularization in 30 patients, radial artery in 28 patients, right internal thoracic artery in 9 patients, cephalic vein in two and one vein graft from the lower extremities in three patients. On average 2.6 grafts/patient were implanted. Complete revascularization was achieved in 21 patients (66%). Two patients died in the postoperative period - one because of sepsis and the other due to malignant dysrhythmias.

Conclusion:
Our preliminary experience with patients with shortage of suitable vein grafts shows that the more common use of arterial grafts even in elderly patients with multiple risk factors does not lead to increased mortality and morbidity. This strategy should be adopted to achieve as complete revascularization as possible. However, we do not recommend the use of both thoracic arteries in obese patients with diabetes.

Keywords: Myocardial revascularization; Shortage of vein grafts

Published: September 1, 2004  Show citation