Analysis Of Harvesting And Application Of The Descending Branch Of The Lateral Circumflex Femoral Artery In Coronary Artery Bypass Grafting

Objective:To observe the harvesting of descending branch of the lateral circumflex femoral artery and the construction of vascular bypass during coronary artery bypass grafting.Methods:Prospective patients who were to undergo coronary artery bypass grafting in our department from December 2016 to October 2019 were selected as the research objects.CT angiography of lower limb arteries was carried out in 54 patients undergoing coronary artery bypass grafting with descending branch of the lateral circumflex femoral artery.This artery was used in 47 suitable patients including 35 male patients,aged between 29 and 62 years old(49.0±7.3).Among them,13 patients were operated off-pump and 34 patients were operated with cardiopulmonary bypass assistance.Results:The course of dLCFA of the 2 patients in this study showed variation.The arteries turned to the deep muscle group earlier,resulting in a shorter length.Two patients had large musculocutaneous puncture branch,resulting in a small trunk of dLCFA and was not usable.Femoral artery occlusion lesions were found in 3 patients.Therefore,dLCFA were successfully harvested and used in constructing coronary bypass grafts in 47 patients.Of the patients,35 were male,aged between 29 and 62(49.0±7.3).Off-pump coronary artery bypass grafting underwent in 13 patients and heart-lung bypass were used in the rest.The length of 47 harvested LdCFA were 7.0-16.2 cm(11.1±1.9);the inner diameter 1.9-3.5mm(2.6±0.4).All the dLCFAs were harvested unilaterally,of which 24 were from the left and 23 from the right.All patients underwent bilateral lower limb arterial CTA before surgery.Compared with radial artery in literatures,dLCFAs had thinner wall similar to the autologous internal mammary artery.In the 47 used dLCFA,40 were used as a free graft,including 28 diagonal,1 anterior descending,2 intermediate and 9 obtuse marginal.For 7 dLCFA with insufficient length,"Y" grafts were constructed with the proximal anastomosed to other grafts.Pedicled left internal mammary artery to left anterior descending arery grafts were used in all the 47 patients and purely arterialized grafts in 26.Bilateral internal mammary artery were used in 14 patients including 8 in situ pedicled right internal mammary arteries.Radial artery was.used in 23 patients after careful preoperative screening,and autologous great saphenous vein in 21.Among the 47 patients,the number of bypass 2-4 per patient,with an average of 3.3±0.7;The incision of the dLCFA healed in one stage,and no complications such as dysfunction and skin paresthesia of lower limbs occurred.Conclusions:The descending branch of the lateral circumflex femoral artery is easy to be harvested and safe to use.It is a clinically feasible arterial bypass vessel in coronary artery bypass grafting.Lower limb arteries CT angiography should be performed before operation,and appropriate bypass establishment strategies should be adopted during operation.