Optimal Method of Coronary Endarterectomy for Diffusely Diseased Coronary Arteries Hiroyuki Nishi, MD, Satoru Miyamoto, MD, Shuichiro Takanashi, MD, Hirokazu.

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Optimal Method of Coronary Endarterectomy for Diffusely Diseased Coronary Arteries Hiroyuki Nishi, MD, Satoru Miyamoto, MD, Shuichiro Takanashi, MD, Hirokazu Minamimura, MD, Takumi Ishikawa, MD, Yasuyuki Kato, MD, Yoshihiro Shimizu, MD The Annals of Thoracic Surgery Volume 79, Issue 3, Pages 846-852 (March 2005) DOI: 10.1016/j.athoracsur.2004.06.070 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Actuarial estimates of survival after coronary endarterectomy with two different techniques. Group O = on-lay patch bypass grafting; Group P = pull-out method. (Pts. = patients.) The Annals of Thoracic Surgery 2005 79, 846-852DOI: (10.1016/j.athoracsur.2004.06.070) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Coronary angiography at 1 month in a patient with a 4.5-cm long endarterectomy and on-lay patch bypass grafting of the internal thoracic artery to the left anterior descending coronary artery. Regular walls and a lumen with an acceptable width can be observed. (B) The reconstruction site became smoother and still preserved a lumen with an acceptable width 41 months after the operation. Good filling of septal perforators is also noticeable. The Annals of Thoracic Surgery 2005 79, 846-852DOI: (10.1016/j.athoracsur.2004.06.070) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Coronary angiography of a patient undergoing the conventional pull-out method of carotid endarterectomy, at the early postoperative stage. The lumen at the endarterectomy and reconstruction site is irregular and patulous. (B) The reconstruction site became irregular and showed string signs 30 months after the operation. The Annals of Thoracic Surgery 2005 79, 846-852DOI: (10.1016/j.athoracsur.2004.06.070) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Evaluation of the status of the intima by intravascular ultrasound sonography at the early and late postoperative stages. In the pull-out method, although the diameters of endarterectomized vessels were wide in the early postoperative stage (A), they became narrow as a result of intimal hyperplasia in the late postoperative stage (B). On the other hand, intimal hyperplasia rarely occurred in group P, even in the late postoperative stage. The intima of the internal thoracic artery became circumferential, and intima was reconstructed in the endarterectomized vessels: (C) early, (D) late. The Annals of Thoracic Surgery 2005 79, 846-852DOI: (10.1016/j.athoracsur.2004.06.070) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions