The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 668-679, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Occlusive changes at the coronary artery--bypass graft anastomosis. Morphologic study of 95 grafts
LS Griffith, BH Bulkley, GM Hutchins and RK Brawley
Ninety-five bypass graft anastomoses in 52 patients dying up to 4 years
after direct coronary revascularization were studied at autopsy by
angiograms and serial histologic sectioning of the graft-artery
anastomosis. When new coronary occlusions and narrowings occurred, they
were adjacent to either the proximal or distal ends of the anastomosis and
were due to compression or loss of circumference of the arterial lumen (40
per cent), thrombus formation (40 per cent), mural dissection of the
coronary wall (8 per cent) or the combination of compression and thrombosis
(12 per cent). Small coronary artery diameter, local atheromas, and
extension of the arteriotomy into a branch vessel were significant factors
predisposing to occlusive changes. The findings emphasize the importance of
careful artery selection for bypass, the need to avoid local vascular
disease and branch-points, and the technical difficulties encountered in
the presence of local vascular lesions or small coronary arteries.
