Pathologic Analysis in Fatal Cases following Saphenous Vein Coronary Arterial Bypass

¹ Department of Pathology, United Hospitals-Miller Division, St. Paul; University of Minnesota, Minneapolis

A pathologic study was done on 53 patients who had received 86 saphewus vein grafts to bypass obstmctive coronary arterial lesions. The periods of study after operation ranged from failure to survive the operation to three and one-half years. Of significance was the high incidence of residual obstructive disease in nongrafted arteries (38 of 53 patients) and in grafted systems (graft and diPtsl artery) (55 of 86 grafts; 64 percent). The residual obstructive disease in the graft systems increased with time after operation. Obstruction was 0 bserved in 30 of the 86 grafts, and in 17 of these 30 the distal artery was also obstructed (usually by residual atherosclerosis). The characteristic basis for occlusion of a graft one month or less after operation was thrombosis. In longer range grafts, occlusion was most commonly caused by fibrous intimal proliferation, although in a small number, organized thrombosis alone or with fibrous intimal proliferation was the basis. In 28 of the 43 patients who survived me month or less, acute myocardial infarction was present at operation or afterward; that is, in 65 percent of the patients who died during the period of hospitalization. Of the 29 acute infarctions, after operation 23 were in a zone supplied by a grafted artery, and six were in a zone supplied by an artery not receiving a graft. In six of the 14 cases of acute infarction in the distribution of an obstructed graft system, the artery proximal to the graft was also occluded by a recent thrombus. Thrombosis in an artery proximal to a graft was observed in one or more vessels in 12 patients who survived the first month after operation. In these, there were ten acute myocardial infarcts, seven of which were in the distribution of the occluded artery.

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