Composite and sequential CABG grafts can develop complex failure modes, such as acting as large collaterals with retrograde flow when proximal segments occlude, necessitating careful angiographic assessment and individualized revascularization strategies.
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Highlights potential retrograde flow in occluded composite grafts; leaves open need for prospective studies on surveillance strategies.
Coronary bypass grafting using conduits with multiple distal anastomoses continues to demand scrutiny. While on one hand these techniques allow the surgeon to avoid or minimise aortic manipulation, the unique flow and pressure characteristics lead to complex forms of graft failure if the anatomy of the target vascular bed is not carefully taken into consideration. We report three cases of graft failure in patients with coronary bypass grafting performed using multiple distal anastomoses, and percutaneous revascularisation in one patient.
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Morakhia et al. (2014) studied this question.
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