Long-Term Results of the Left Anterior Descending Coronary Artery Reconstruction With Left Internal Thoracic Artery

Myocardial ischaemia due to stenosis of the subclavian artery

“…Bypasses with internal thoracic artery remain patent after 10 years in 90% of cases. The results are peculiarly satisfactory in patients who underwent a bypass from the aforementioned vessel to the descending anterior branch of the left coronary artery [1,2]. In a proportion of bypass (internal thoracic-coronary artery) failure cases disturbances of blood flow in the subclavian artery due to its stenosis are observed [3].…”

Patch Angioplasty in Diffusely Diseased Left Anterior Descending Coronary Artery

“…Among this population are patients with diffuse coronary disease who were before deemed inoperable and managed medically, with substantial number having persistent symptoms and restricted physical activity [4]. With a diffusely diseased LAD that is frequently encountered in this patient population, complete myocardial revascularization is hardly achieved by conventional bypass techniques [6,8] and the long-term patency of a LIMA to LAD graft is usually jeopardized by the multiple atheromatous plaques [9] several technical variations and surgical combinations have been suggested to reconstruct the diffusely diseased LAD that included: jumping anastomosis and creation of more than one bypass to the LAD territory, endarterectomy, venous patch angioplasty followed by LIMA anastomosed on the patch [10] and extended LIMA patch angioplasty, with or without endarterectomy [1,4,6,[11][12][13].…”

“…15 With the increased use of percutaneous interventions by invasive cardiologists, the number of high-risk patients referred for CABG operation has increased [6]. Among this population are patients with diffuse coronary disease who were before deemed inoperable and managed medically, with substantial number having persistent symptoms and restricted physical activity [4].…”

“…The technique and extent of endarterectomy are also subjects of debate. For some, endarterectomy should be limited [6,12] others advocate for more liberal use with total removal of the plaque under direct vision [1,7,11].…”

“…venous patch when using saphenous venous patch with plaque exclusion for more than 2 cm and; a diffusely diseased LAD was defined as a diseased segment measuring 2 cm or more, involving the middle and distal thirds of the LAD [1,4,6]. Table 1 shows the patients' demographics.…”