Angiographic appraisal of distal vessel suitability for aortocoronary bypass graft surgery

The accuracy of preoperative coronary arteriography in determining distal vessel operability was evaluated in 166 patients studied arteriographically before and after bypass surgery. Appraisal accuracy correlated closely with the type of distal vessel filling, being highest (97%) in poststenotic vessels with antegrade filling; lower (76%) beyond occlusions with generous retrograde collateral flow; and least (65%) in postocclusion vessels filled by insufficient collaterals. Optimum data collection is favored by the use of high definition serial roentgenography with extended filming in multiple projections; competent interpretation requires the integrated assessment of interdependent variables, including distal vessel morphology, filling patterns, branch disease, run off capacity, and myocardial status.