Nonreversed saphenous vein grafts for coronary artery bypass grafting.

Between August 1985 and December 1988, valvotomized saphenous vein grafts were used in 365 patients undergoing coronary artery bypass grafting (CABG). In this operation, the femoral end of the vein is attached to the aorta and the pedal end is attached to the coronary artery. Vein diameters measured 8 +/- 2 mm at the femoral end, 4.5 +/- 1.2 mm at the knee level, and 3.5 +/- 1.3 mm at the ankle. Ratios between levels were as follows: knee to femoral end, 0.56, and ankle to femoral end, 0.43. The ratio of knee to femoral end was 0.42 in cases with vein midthigh bifurcation. There were 1,310 grafts implanted (3.6 per patient). In 341 patients, CABG alone was performed, and 24 patients had combined procedures: 11 had CABG with mitral valve replacement, 9 had CABG with aortic valve replacement, 2 had CABG with repair of postinfarct ventricular septal defect, and 2 had CABG with automatic defibrillator implantation. Follow-up (up to 3.5 years) was attained in 97% of patients. For various reasons, 34 patients had a second angiogram between 3 and 41 months postoperatively. Of 120 vein grafts, 108 (90%) were patent. At autopsy, 11 patients with 45 vein grafts had 43 patent and clean grafts and two thrombosed. Use of nonreversed saphenous vein for coronary bypass is recommended. It assures a large proximal anastomosis, natural vein bifurcations can be used with fewer proximal anastomoses, better vein-coronary artery size matching is obtained, and the patency rate is satisfactory.