A Modified Reconstruction Technique After Extended Anterior Descending Artery Endarterectomy

An increasing number of patients with advanced coronary artery disease and diffusely complex atherosclerotic lesions are referred for coronary artery bypass surgery (CABG). Under these circumstances, complete myocardial revascularization with an adequate distal runoff can only be achieved by extensive manual endarterectomy and a reconstructive procedure prior to conduit placement. Because of the numerous septal and diagonal branches of the left anterior descending artery (LAD), an extended and meticulous endarterectomy is warranted. Placement of the internal mammary artery (IMA) on such a widely opened vessel requires reconstruction with a vein patch and the IMA. A modified technique of extended manual endarterectomy, distal vein patch, and proximal IMA reconstruction and revascularization is described. This technique was used in six patients between October 1990 and December 1992 with 100% early survival. This technique is less time consuming and more importantly allows for a direct artery-to-artery anastomosis with the potential for a better long-term patency.