The arterial sling operation:: One-year follow-up

Background. Coronary artery bypass graft surgery with total arterial revascularization, particularly the use of bilateral in situ internal thoracic arteries, is considered an improved treatment of patients with ischentic heart disease. The sling operation connects the internal thoracic arteries with the radial artery, creating an arterial arcade with double inlet of blood to the peripheral vascular bed. In this paper we present 1-year follow up of angiographic and clinical results of the arterial sling operation. Methods. The arterial sling operation was performed in 28 patients in the period from October 2000 to September 2001, and all patients were offered an angiographical and clinical examination 1 year postoperatively. All angiograms were systematically reviewed by an interventional cardiologist and a cardiac surgeon. Results. Twenty-three patients participated in the 1-year angiographic follow up. Of these 3 patients had a fully open arterial sling, 15 patients had stenosis or occlusion of one segment, and 5 patients had occlusion or stenosis of 2 segments of the radial artery. Eight of the total 93 peripheral anastomoses were occluded. The 1-year graft patency rate was 91.4%. Conclusions. The arterial sling operation is safe and the one year patency rate is high. Although one or two segments of the arterial sling may degenerate due to competitive blood flow, this does not affect blood flow in the vascular bed in patients without disease progression. However, arterial revascularization should be performed in a way to minimize competitive flow.