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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.

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