Sequential saphenous vein coronary bypass graft with patency of 22 years.

A76-year-old woman who had a coronary artery bypass using a sequential saphenous vein graft to the diagonal branch and the left anterior descending artery (LAD) remained free of chest pain for 22 years. She was recently diagnosed with critical aortic valve stenosis. Cardiac catheterization showed the sequential saphenous vein graft was patent. The size of the graft was remodeled according to the volume of blood flow. The distal part of the graft, from the anastomosis of the diagonal branch to the LAD, carries blood to the LAD only. The proximal part of the graft, from the aorta to the diagonal branch, carries blood to both the diagonal branch and the LAD. Consequently, the diameter of the graft in the proximal part is larger than in the distal part (Figure).