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Page 6 of 11 Elsayed et al. Vessel Plus 2018;2:39 I http://dx.doi.org/10.20517/2574-1209.2018.65

Figure 1. Representative image of CT coronary angiography showing left internal mammary artery (LIMA) patch with patent LIMA-left
anterior descending artery anastomosis

Table 4. Comparison between pre and postoperative New York Heart Association class

Preoperative (n = 30) Postoperative (n = 29)
NYHA class Z P
No. % No. %
I 0 0.0 20 69.0
II 15 50.0 9 31.0 4.919* < 0.001*
III 15 50.0 0 0.0
*Statistically significant at P ≤ 0.05; Z and P values for Wilcoxon signed ranks test for comparing between pre and postoperative; NYHA:
New York Heart Association

Table 5. Comparison between pre and postoperative ejection fraction
Preoperative (n = 30) Postoperative (n = 29) T P
Ejection fraction
Min-Max 35.0-70.0 48.0-68.0
Mean ± SD 51.23 ± 9.02 56.28 ± 5.62 4.968* < 0.001*
Median 49.0 58.0
*Statistically significant at P ≤ 0.05; T and P values for Paired t-test for comparing between pre and postoperative

Endarterectomy entails removal of the atherosclerotic core from the coronary vessel. In closed
endarterectomy (also called pull out method) a small arteriotomy is used to dissect the atherosclerotic plaque
out of the coronary vessel by using steady and gentle traction. It’s a simpler technique but was criticized due
to the possibility of occlusion of the distal LAD or its branches by insufficient endarterectomy the so called
[7]
snowplow effect . In addition blind traction on the atherosclerotic core can lead to tears and iatrogenic
intimal flaps that would lead to occlusion of the coronary vessel .
[8]
In open endarterectomy a longitudinal arteriotomy is performed on the coronary vessel beyond the limits
of the atheromatous plaque and the atherosclerotic plaque is dissected under vision from the coronary vessel
and its side branches avoiding any residual obstruction and repairing any intimal flaps that might occur
during the removal of the plaque. The coronary is then reconstructed using an onlay patch of saphenous
vein or LIMA itself. Advocates of coronary reconstruction using the saphenous vein patch suggested
[6,8]
that it is very easy to use, easy to harvest and enlarged the lumen of the reconstructed LAD . However
others accused it of being more time consuming, as you convert one anastomosis into two anastomoses,
first anastomosis of saphenous vein graft (SVG) to the endarterectomized LAD, then anastomosing the
LIMA onto the saphenous vein patch. It was also suggested that this complex vascular bed formed of three