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Page 10 of 11 Elsayed et al. Vessel Plus 2018;2:39 I http://dx.doi.org/10.20517/2574-1209.2018.65

Endarterectomy leaves behind a coronary vessel denuded of endothelium. This bare area acts as a nidus
for thrombus formation and triggers a rapid coagulation cascade in the early postoperative period and can
explain the high rate of postoperative MI. Therefore it seems obvious that thromboprophylaxis serves as
a cornerstone in the outcome of those patients. Nevertheless anticoagulation regimens followed are based
on surgeon’s experience. This is due to lack of randomized controlled studies and the fact that there are no
recommendations on anticoagulation and antiplatelet therapy in endarterectomy patients published in the
guidelines yet.

[3]
In a recent review by Soylu et al. perioperative MI ranged from 0 to 19 percent, cerebrovascular accident
ranged from 0 to 6 percent and the operative mortality ranged from 0 to 19 percent. Coronary endarterectomy
was accompanied by acceptable patency rates, that ranged from 56% to 100% at a post-operative follow-up
ranging from 6 months to 10 years. Our results match the results of large series in the literature.

In the current era, coronary endarterectomy appears as a valuable surgical option in diffusely diseased
coronary vessels. With appropriate indications and in experienced hands, it can be done with acceptable
morbidity, mortality, angiographic patency rates and lead to favorable outcomes in a high risk cohort.

In conclusion, results of reconstruction by LIMA and saphenous vein patch are comparable in short term
follow up.

DECLARATIONS
Acknowledgments
Dr. Bassem Ramadan for sharing his expertise in coronary reconstruction.

Authors’ contributions
Collection of data, analysis, follow up of patients, writing up the manuscript: Elsayed MH
Design of the study and revision, operated most of the cases: Hassanein WM
Revision of the manuscript: Keshk SA, Etman WG
Follow up of cases: Zidan M

Availability of data and materials
Alexandria University Cardiothoracic Surgery Department database.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Informed consents were obtained from all patients prior to the procedure with explanation regarding
the aim of the procedure and the possible side effects according to the guidelines of ethical committee at
Alexandria Faculty of Medicine.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.