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First Septal Artery: Direct or Indirect Grafting

We retrospectively analyzed the revascularization of the septal artery achieved either directly through a coronary artery bypass graft (CABG) to the first septal artery (S,), or indirectly through endarterectomy and CABG of the left anterior descending coronary artery (LAD). From July 1, 1976 to May 1, 1979, 21 patients received CABG to S,. A postoperative angiogram was obtained in 13 patients and the patency rate was 84% (11 of 13). During the same period, 15 patients with a large S1 received endarterectomy and CABG of the LAD. Six of these 15 patients (40%) had an excellent flow into S1 as seen on the postoperative angiogram, whereas nine (60%) showed no improvement. The vein graft was patent and considered normal in 14 patients and the distal flow in the LAD was adequate in 10 patients (66%).We conclude that better revascularization of S, is achieved by direct CABG. However, endarterectomy of the LAD allows revascularization of arteries that could not be grafted otherwise because of severe diffuse disease.