[HSF] DES-SVG anastomosis

[Tohru Asai]

Mladen
A Brave man! I have occasionally encountered multistent cases for CABG. As
Igor mentioned, I also stay away from stented sites and grafting distals
with arterial sequential anastomoses. The advantage of arterial graftings is
lower rate of thrombotic occlusion no matter how small target vessels are.
The only occasion I would use vein grafts is mildly stenotic stented vessel,
which is really a pain in the ass. Maybe I should pinch stent with
needle-holders or something to make real stenosis.

One important thing I found in OR with these cases is the strange quality of
distal target sites. The target artery is not only small in caliber but the
vessel wall appeared to be inflammed or thickened almost always. And
perivascular tissue looks edematous or inflammed as well. Usually I need
extreme concentration and care to construct anastomoses compared to ordinary
cases. Does anybody agree with my impression?

Like Don said, Aspirin in the early postoperative phase may not be as
effective as in preoperative period due to resistance. Additional
medications such as Plavix or even Warfarin should be added.

As we discussed in the thread "Full Metal Jacket", my strategy is
multiarterial sequentials into the distal sites in off-pump fashion. And
early postop validation with MDCT and/or angiograms. Outcomes have been so
far so good. Obviously these are different kind of patients group.
-- 
Tohru Asai