8 REVERSED SAPHENOUS VEIN WITH PROXIMAL ATTACHMENT OF FREE RADIAL ARTERY SEGMENTS—A NEW APPROACH TO CORONARY REVASCULARIZATION V. A. PICCONE, M.D., F.A.C.A., H. H. LEVEEN, M.D., R. KHAN, M.D., AND N. AHMED, M.D. While increased longevity from coronary revascularization now is becoming evident, 1, 9. 10 techniques for revascularization should continue to undergo development and change.’° The 25% failure rate of individual saphenous vein grafts by three years,9. 1° the low flow of’ internal mammary artery bypass grafts,’ the high late closure rate of gas endarterectomized coronary arteries,11 the difficult and dangerous aortic anastomosis of the Carpentier operation,2 2 and the more extensive operation for splenic artery bypass to the coronary arteries’ continue to spur the development of’ more optimal procedures. Free radial artery grafts from the most proximal part of’ a reversed segment of saphenous vein graft avoid the difficult aortic anastomosis of the Carpentier operation and offer the long term patency of’ arterial grafts with a vessel having (1) greater capacity for flow than the internal mammary artery and (2) a size which closely approximates that of’ the coronary arteries. This concent depends on the fact that obstructed vessels become thrombosed proximally up to the first collateral branch. If’ the vein graft from which the free radial artery takes origin should undergo distal thrombosis, the free radial artery segments remain open and continue to supply the remaining coronary arteries. This manuscript describes the initial clinical experience with composite grafts using free radial artery segments grafted from the proximal end of’ an aorto-coronary vein bypass to the appropriate areas of’ the other diseased coronary arteries. CLINICAL MATERIAL All patients had multiple coronary artery disease as determined by selective coronary cineangiography. Triple vessel disease was present in ten patients and three patients had double vessel disease. Stable angina and preinfarction angina were the indication for angiography. Ventricular function was impaired in several patients. METHODS Multiple coronary bypass grafts were performed in thirteen patients using reversed saphenous vein with proximal attachment of’ free radial artery bypass grafts to other diseased coronary arteries. The operations were performed Presented at the Twenty-First Annual Meeting of’ the American College of Angiology in San Juan, Puerto Rico, February 23-March 2, 1975. From Department of Surgery, State University of New York, Downstate Medical Center and Brooklyn Veterans Administration Hospital, 800 Poly Place, Brooklyn, New York 11209.