[20 years of surgical coronary revascularization. The importance of arterial grafts].

Myocardial revascularization surgery by means of a saphenous aortocoronary by-pass is in its third decennial of employment. Also if it has been proved of value in bettering the survival in various kind of anatomical lesions, and in resolving the anginal symptomatology in a majority of patients, it has been granted of a simple palliative surgical procedure in view of the evolutive characteristic of arteriosclerotic disease and of the progressive degenerations of the internal saphenous vein. The wide use of arterial transplants, internal mammary artery and gastroepiploic artery, gives these patients satisfying results. Due to the more technical complexity of its preparation and anastomosis, internal mammary artery was very late adopted by surgeons. Nevertheless it has acquired a title of noblesse demonstrating its long survival, and in the meantime has given an impulse to the use of the gastroepiploic artery. According to our experience 80% of our patients can obtain a complete revascularization using exclusively simple or sequential arterial transplants. Also if this surgery must rightly be considered a palliative one, for its long term results of survival and quality of life it shows a curative value.