Side-to-side Anastomosis Technique using Four Interrupted Sutures for Sequential Grafting with an Arterial Graft

Multivessel coronary artery bypass grafting (CABG) for complex or damaged small coronary lesions has been increasingly performed because of recent advances in percutaneous coronary intervention . Although sequential bypass using arterial grafts is essential for achieving complete revascularization and long-term patency with complex multivessel diseases, technical difficulty exists for patients with target coronary arteries smaller than 1.0 mm in diameter. Tashiro et al. developed the side-to-side anastomosis technique with 4 interrupted sutures for sequential CABG using the saphenous vein and radial artery and reported that this technique is effective for implementing complete revascularization of complex coronary lesions 2, . However, mismatch between a large graft such as the saphenous vein and a small coronary artery might have potential risks, thereby compromising long-term patency. To avoid size mismatch between the graft and coronary artery, small-caliber arterial grafts (such as internal thoracic arteries [ITAs] and right gastroepiploic artery [RGEA]) may be suitable for this technique. In this study, we evaluated the effectiveness of the side-to-side anastomosis technique with 4 interrupted sutures for sequential grafting between small coronary arteries and arterial grafts.