Medical therapy for multivessel CAD was associated with a lower incidence of short-term events and a reduced need for additional revascularization, compared with PCI. In addition, CABG was superior to MT for eliminating anginal symptoms. All three therapeutic regimens yielded relatively low rates of cardiac-related deaths.

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Background: Cardiovascular surgery has been undergoing transformations due to the advancement of percutaneous techniques, clinical treatment and primary prevention.

We present the initial experience with the use of inferior epigastric artery as a free graft for myocardial revascularization in a series of 41 patients operated on between 1987 and 1989 to show the clinical and angiographic results. Of the 41 patients, 29 were male, 12 female, with ages ranging from 33 to 72 years, and weights from 50 to 86 kg. The inferior epigastric artery grafts were predominantly employed to the anterior interventricular branch and diagonal branch. The proximal anastomosis into the aorta was done directly or with a patch of vein or pericardium. The 32 patients who survived had mean follow-up of 82 months and 22 are in functional class I, 8 in class II and 2 in class III of angina. The early patency rate was: inferior epigastric artery-anterior interventricular branch, 85.7% and inferior epigastric artery-diagonal branch. 85.7%. Sixteen patients underwent angiographic study at a mean follow-up of 81.2 months and the patency rate to the anterior interventricular branch was 77.7% and to the diagonal branch was 100%. Three patients with early occluded inferior epigastric artery were reoperated on 3, 3 and 11 months after the operation. A filiform lumen of the graft and a small ostium in the aorta was found and explained the imperfection of the direct anastomosis due to unbalance thickness of the graft and the aortic wall. Therefore it is occluded that the inferior epigastric artery is an alternative arterial graft for myocardial revascularization and that the use of a vein or pericardium patch can help the proximal anastomosis and improve potency of the graft.