Journal «Angiology and Vascular Surgery» • 

2015 • VOLUME 21 • №4

Fasciotomy as a method of surgical preparation of a conduit for coronary artery bypass grafting

Vechersky Yu.Yu., Zatolokin V.V., Eremenko K.V., Andreev S.L., Shipulin V.M.

Scientific Research Institute of Cardiology, Tomsk, Russia

The study included a total of 59 patients undergoing coronary artery bypass grafting with the use of the radial artery (RA). Group One consisted of 28 patients who while preparing the conduit were subjected to longitudinal dissection of the fascial compartment (fasciotomy) of the RA. Group Two comprised 31 patients not undergoing fasciotomy. In Group One patients prior to fasciotomy, 2 segments were cut off from each RA and incubated in a hypo osmotic solution either in the fascial compartment (n=28) or after fasciotomy (n=28) followed by morphometric analysis. Therapeutic results in all patients were studied averagely 3.3±0.8 years after surgery. 32 patients underwent control coronary bypass angiography averagely 2.5±0.54 years after the operation.

The morphometric analysis of the RA segments in conditions of simulated oedema revealed that a more pronounced decrease in the RA lumen (by 49.7%) was observed in the segments kept in the fascial compartment as compared with the segments after fasciotomy (1.08±0.12 mm and 2.21±0.09 mm, respectively, p=0.0129).

In the remote period after the operation (mean 3.3±0.8 years) Group One patients were found to have fewer cases of renewal and increase of the angina class (n=3; 10.7%) than Group Two patients (n=7; 22.5%; p=0.0289). There were no cases of secondary myocardial infarction in Group One patients, whereas in Group Two there were 2 (6.5%) cases of myocardial infarction in the postoperative period.

Based on the findings of coronary bypass angiography, patency of the RA in Group 1 was higher than in Group 2 (91.6 and 78.6%, respectively; p=0.0371).

The obtained results are suggestive that fasciotomy of the RA during surgical preparation of the conduit is appropriate, thus decreasing the risk of blood flow reduction via the arterial bypass graft and improving the outcomes of autoarterial coronary bypass grafting.

KEY WORDS: autoarterial coronary bypass grafting, radial artery, conduit preparation.

P. 169

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