Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 219

Some grafts connect to two or multiple distal targets. A sequential graft (or jump graft) connects to one branch, e.g. OM1, in a side-to- side anastomosis, then continues and connects to another branch, e.g., OM2, in an end-to-side anastomosis. A split graft (or Y graft) consists of a graft A that connects to one branch and a second graft B that is anastomosed to graft A and that separately connects to another branch. Sequential and split grafts reduce the number of aortic anastomoses and may improve patency in light of the higher flow across the graft. However, when the runoff is good, grafts with single targets have a higher patency than sequential grafts.^104,105 Sequential grafting is useful in patients with poor runoff or patients with limited venous conduits (e.g., varicose veins). The best sequential graft patency is obtained by placing the last distal anastomosis onto the coronary branch with the greatest runoff, while the smaller coronary branch is anastomosed more proximally in a side-to-side fashion (e.g., graft to diagonal and LAD, LAD being the last anastomosis); this allows an increase in flow throughout the whole graft.¹⁰⁵