Endarterectomy in the Treatment of Coronary Artery Disease

Fifty years of coronary artery bypass grafting

“…Before grafts were routinely used for coronary surgeries, direct operation on the coronaries advanced again in 1961, when the Swedish surgeon Ake Senning enlarged the lumen of a left main coronary artery using a pericardial patch (11). Only a few months later, on the other side of the Atlantic ocean, the Cleveland Clinic and Donald Effler applied this pericardial patch technique to both (left and right) coronaries (12).…”

Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery

“…CE can be performed with closed (traction) or open (direct vision) methods. On the one hand, closed endarterectomy is simpler and easier to reconstruct [2,3], but complete removal of the atheromatous plaques is frequently impossible; on the other hand, open endarterectomy allows complete removal of atheromatous plaques from the main vessel and the side branches under direct vision [16,17]. Nishi and colleagues [18] reported a better midterm angiographic patency rate for CE with a long arteriotomy than for traction endarterectomy.…”

“…In these cases, coronary endarterectomy (CE) can be an effective surgical option [1]. CE, which was first introduced in 1957 by Bailey and colleagues [2], was initially associated with increased operative morbidity and death [3,4]. Even in the recently published meta-analysis of 63,730 patients, Wang and colleagues [5] reported that CE-CABG not only increased 30-day mortality from 2.8% to 5.4% (odds ratio, 1.86), but also led to significantly unfavorable results in myocardial infarction (MI) and low-output syndrome.…”

The father of coronary artery bypass grafting: René Favaloro and the 50th anniversary of coronary artery bypass grafting

“…Encouraged by the favorable endarterectomy experience in treating carotid and peripheral vascular disease and experimental endarterectomy in dogs and human hearts obtained at autopsy, segmental occlusions of major coronary arteries were approached by endarterectomy by Bailey and colleagues (1957), 21 Longmire and colleagues (1958), 22 Effler and colleagues (1964), 23 and others thereafter. Inspection of the epicardium and palpation of the coronaries guided placement of the incision.…”

“…Endarterectomy was soon abandoned because of the shearing effect on the side branches and the often problematic distal dissection flap, 23 and patch coronary arterioplasty, a technique described by Dr Ake Senning, was adopted. 24,25 In 1962, the Vineberg procedure was validated by selective ITA angiography of 3 patients operated on by Dr Wilfred Bigelow at Toronto General Hospital and referred to Cleveland.…”