-Original-

Pilot Study of the Composite Graft Constructed from Two Saphenous Veins with a Single Inflow Source in Coronary Artery Bypass Grafting with Atherosclerotic Ascending Aorta

Makoto Shirakawa, Atsushi Hiromoto, Jiro Honda and Yosuke Ishii

Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan

Background: This pilot study aimed to evaluate early outcomes of a composite graft constructed from two saphenous veins (SVs) with a single inflow source in coronary artery bypass grafting (CABG) for patients with an atherosclerotic ascending aorta. The analysis focused on prevention of embolic events and early graft patency.
Methods: The analysis included 17 patients who underwent CABG using the left internal thoracic artery (LITA) to the left anterior descending artery (LAD), combined with a composite graft constructed from two saphenous veins (SVs) with a single inflow source. The SV composite graft was anastomosed to non-LAD coronary territories.
Results: Intraoperative flow and pulsatility index values of the SV grafts were satisfactory. No major complications, including new cerebrovascular embolic events, were observed. The early patency rate of SV anastomoses was 90%; all four occlusions among the total 40 anastomoses occurred in the Y-shaped composite graft.
Conclusions: A composite graft constructed from two SVs with a single inflow source appears to reduce the risk of embolic events by minimizing manipulation of the atherosclerotic ascending aorta. However, the configuration of the proximal SV anastomoses may affect early graft patency. Specifically, the risk of early failure appears to be higher in the Y-shaped configuration than in the V-shaped configuration.

J Nippon Med Sch 2026; 93: 115-121

Keywords
coronary artery bypass grafting, saphenous vein, composite graft, embolic event, graft patency

Correspondence to
Makoto Shirakawa
s5051@nms.ac.jp

Received, August 29, 2025
Accepted, November 12, 2025