Hellow guys, Welcome to my website, and you are watching CABG -Total Arterial Revascularisation with LIMA, RIMA & LRA. Excellent long term patency of grafts. and this vIdeo is uploaded by Dr. S. K. Varma, Cardiothoracic Surgeon, India at 2020-07-31T03:24:22-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | CABG -Total Arterial Revascularisation with LIMA, RIMA & LRA. Excellent long term patency of grafts |
| Video Uploader | Video From Dr. S. K. Varma, Cardiothoracic Surgeon, India |
| Upload Date | This Video Uploaded At 31-07-2020 10:24:22 |
| Video Discription | CABG with arterial conduits are known to have excellent long term outcomes. The common arterial conduits used include the left and right Internal Mammary Arteries and the Radial Artery from the non dominant hand. This video illustrates excellent patency of all the arterial grafts used during the CABG of this gentleman over 16 years ago despite he being lost to followup for a long time after surgery and continuing to smoke after his CABG. During the CABG, the pedicled left Internal Mammary artery graft was used for the LAD, the pedicled Right Internal Mammary Artery Graft was used for the proximal PDA and the left Radial Artery was used as a free graft for an obstructed major Obtuse Marginal Artery. Despite irregular followup and continuing to smoke, the arterial conduits have demonstrated excellent long term patency. As many arterial conduits as possible should be routinely used during CABG in this day and age especially in younger patients. The Internal Mammary Arteries are in close proximity to the heart situated on the under surface of the sternum, they are elastic arteries having very little smooth muscle in their walls (less prone to spasm) and can be used as pedicled grafts that require only a "distal anastamosis" onto the native coronary artery. The radial artery is used as a free graft that requires a "distal and proximal anastamosis" to be performed. Arterial grafts can be used on diffusely diseased native coronary arteries (as illustrated in this video) as well. The endothelium of the Internal mammary arteries is also known to secrete endothelium derived relaxing factor (EDRF) which helps to dilate the down stream native coronary arteries thereby ensuring successful long term revascularisation and excellent palliation of angina. The Left Internal Mammary Artery is usually used as a pedicled graft for the LAD. The right Internal Mammary Artery may be used as a pedicled graft or as a free graft with its proximal anastamosis onto the side of the LIMA as a "Y" configuration or onto the ascending aorta itself. The Radial Artery of the non dominant hand is generally used as a free graft onto a major branch of the Circumflex. Its proximal anastamosis can be done onto the side of the LIMA in a "Y" configuration or onto the ascending aorta itself. Apart from the LIMA, RIMA and RA, the right Gastroepiploic Artery can also be used as an arterial conduit especially for the posterior descending branch of the RCA. This need a short extension of the sternotomy incision into the abdomen. The pedicled right Gastroepiploic Artery after harvest from the greater curvature of the stomach can be used to graft the PDA through a small surgically created rent in the right dome of the diaphragm. Use of both Internal Mammary Arteries must be carefully done in obese diabetics, those with COPD /Asthma and elderly patients who have an osteoporotic sternum. In all the aforementioned situations, the incidence of sternal dehiscence is higher. The decision regarding the choice of conduits in the aforementioned situations is a clinical judgement call by the operating surgeon. www.skvarma.com www.theheartandlungclinic.com |
| Category | Science & Technology |
| Tags | www.skvarma.com | www.theheartandlungclinic.com |
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