RES: [HSF] Re: [HSF ] OPCAB pitfall

[Donald Ross]

Theofilo,
I am sure your greater effort to achieve total arterial  
revascularisation is better than using a vein and will probably  
protect you from graft thrombosis in even severe cases of  
thrombophilia. There is no data of course but a can't recall an  
arterial graft failing in this manner.
Why then do we occasionally use vein?
Apart from non-significant lesions where an artery is containdicated  
the words lazy and stupid come to mind. Although in some elderly  
obese arteriopathic folk it may be meddlesome to take out another ima  
or do a laparotomy.
What about putting the proximal SVG onto the ima?
This has been done in our unit for some time without any apparent  
problems mainly to avoid aortic manipulation. We believe it should  
not be attempted if the vein is > 1 1/2 times the size of the ima at  
the site of anastomosis. It is sometimes done even for prophylactic  
vein grafts providing there is a competent valve in the vein to  
prevent back flow from the coronary into the ima which could  
compromise it due to competitive flow.
Don

On 01/02/2007, at 2:04 AM, Theofilo wrote:

> Dear Don,
> I've being doing BIMA's for more then 3 years now, mostly inspired  
> by you,
> and hipercoag is something that calls the attention in OPCAB -  
> mainly in
> endarterectomies where in initial cases I had 1 AMI interrupted by
> mechanical thrombolisys and Antiplatelet drugs with considerable  
> muscle
> loss. I used only a few SV attached to LIMA ("Y") fashion with no  
> knowledge
> of problem (no knowledge). Since then I'm also always concerned about
> hipercoag post anastomosys. Anyway the hole thing doesn't look ok  
> to me and
> now I wouldn't put a vein unless no RIMA, Radial or Epigastric  
> available.
> Would you tell us if you've seen the same problem with arterial or  
> it's a
> venous thing?
> BIMA's and OPCAB the medicine for CAD and stents as well.
> Theofilo Gauze
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