[HSF] Full metal jacket

[Tohru Asai]

Dear Zhandong
Don has already answered his strategy. But I would put my thought as
well.Hope it helps.

> How to you make the incision on the vein graft?.
longitudinal

> Do you do anything different if the vein is small but do not have
> enough vein. 
No. Vein is almost always larger than artery, so I don't care. But if its
quality is poor,I will harvest other arterial conduit.

> How many maximal sequential anastomosis you will do?
As far as its size and course look fine, max 4 for SVG, Max 3 for LIMA, Max
3 for GEA.

> Do you 
> believe sequential is better than single?
It depends. Single vein to thin target with poor run-off will not survive in
long term, I guess. But we don't know real data.

> When you do LIMA to Diag and LAD,
> how do you make incision on the LIMA.
Longitudinal. Lately I do RIMA to LAD, then LIMA to Diag and OM more often,
give a little more respect to LAD ( deserve for single IMA).

> is diamond anastomosis better?
I use "diamond" or "parallel"(in-line by Don), depending on the more natural
angle between the conduit and the side-to-side target site. And in thin
arterial grafts, I generally avoid diamond anastomosis.and use parallel
anastomosis often. In diamond, I make incision on arterial (or vein) graft
no more than 1/3 of its circumference in order to avoid seagull deformity.
In most cases, I usually use diamond for SVG, GEA, RA and some IMA with care
taken for reasons mentioned above. On the contrary, I generously use
"parallel" anastomosis quite often when the angle is OK.
-- 
Tohru Asai