Lower versus upper leg saphenous vein composite grafts based on the left internal thoracic artery: A randomized study.

Abstract

The "lower versus upper leg saphenous vein (SV) composite graft based on the left internal thoracic artery (ITA) for coronary artery bypass grafting" trial was designed to compare the histologic, immunohistochemical, and angiographic findings of lower versus upper leg SV composite grafts. Twenty-six patients with multivessel coronary artery disease were prospectively randomized to undergo revascularization using a lower leg (n = 13) or upper leg (n = 13) SV composite graft based on the in situ left ITA. The SV was harvested with a "no-touch" technique, and 2 excess segments were removed from the distal and proximal portions of each SV conduit. Another proximal segment was removed from the reversed SV composite graft, which had been dilated by the native ITA pressure. Hematoxylin and eosin staining, immunohistochemistry, and early and 1-year postoperative angiographic results were compared. The histologic study showed that the proximal and dilated proximal SV conduit lumen diameters were smaller in the lower leg group than in the upper leg group (proximal, 623 ± 143 μm vs 858 ± 266 μm; P = .008; dilated proximal, 1138 ± 419 μm vs 1477 ± 353 μm; P = .047). However, there were no differences in the lumen diameters of the distal SV segments in terms of immunohistochemical comparisons, diameters, patency rates, or filling frame counts of the SV conduits on early and 1-year postoperative angiograms between the 2 groups. Although the proximal segment luminal diameters were smaller in the lower leg SV, there were no differences in the immunohistochemical results or patency rates on early and 1-year postoperative angiograms between the lower and upper leg "no-touch" SV conduits.