Further evaluation of the circular sequential vein graft technique of coronary artery bypass.

Our study reports a series of circular sequential vein grafts in 21 patients with highly symptomatic triple-vessel coronary artery disease. Four or more distal anastomoses were done in each patient. Thirteen of the patients were restudied, and the results revealed a 97% patency rate for distal anastomoses (58 out of 60) at 4 to 13 months after operation. One patient died 2 months after operation. Postmortem examination revealed a desmoplastic, fibrotic reaction at the proximal anastomosis of the circular graft, with 3 of 4 distal anastomoses patent. Twenty of the 21 patients in this series are now alive with asymptomatic cardiac status 14 to 22 months after operation. The finding by Grondin and associates [1] of increased patency rate with this technique for distal anastomoses is confirmed. The circular sequential vein graft represents a particularly advantageous technique for patients in whom 4 to 6 distal anastomoses are needed for complete revascularization and in whom one or more vessels have limited runoff. The obvious disadvantage of this technique is that all distal anastomoses depend on a single proximal anastomosis.