*5.4.1 Greater saphenous vein*

The greater saphenous vein (**Figure 8**) is the most commonly used conduit for CABG. The greater saphenous vein (GSV) of the lower extremity is the best choice of this type of graft based on:


Usually a single long segment is harvested. About 12–15 cm segment may be needed for diagonal branch, about 20–24 cm length for OM branches, and 18–22 cm

**Figure 7.** *Splenic artery.*

length for RCA and PDA coronary arteries. Poor quality and veins with varicosities should be avoided. Branches can either be ligated or clipped. These should be ligated or clipped; just flush with GSV to avoid the narrowing or diverticulum. Creation of skin flaps should also be avoided.

GSV is harvested in two different ways:

*DOI: http://dx.doi.org/10.5772/intechopen.88932*

*Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks*

term patency is also lesser than saphenous veins [12].

• A median sternotomy is done (**Figure 10**).

• The same time arterial or venous conduit is harvested.

• LIMA is divided distally and a bulldog clamp is placed on the artery.

• Purse string sutures are placed on the ascending aorta and right atrial

• A purse string suture is placed on the ascending aorta for cardioplegia

• Distal segment of LIMA on the chest wall is ligated or clipped.

• The pericardium is opened and pericardial stay sutures placed.

• Endoscopic vein harvest

*5.4.2 Short saphenous vein*

prone or supine position.

*5.4.3 Cephalic vein*

**6. Types of CABG**

2.Off-pump CABG.

1.Traditional on-pump CABG.

3.Minimally invasive direct.

4.Totally endoscopic CABG.

**6.1 On-pump CABG technique**

• LIMA is harvested.

• Full-dose heparin is given.

appendage for cannulation.

• Aortic and right atrial cannulae are inserted.

cannulation.

**91**

• Directly by single full incision or through multiple incisions (**Figure 9**)

In rare cases when not enough conduits are available, some surgeons have to use short saphenous vein (**Figure 8**). It can be harvested by positioning the patient in

Even though we have not used the vein as alternative graft, this can be used in the case other grafts need it. The cephalic vein can be harvested from the wrist up to the shoulder. The walls of the vein are thinner than the saphenous veins, and long-

**Figure 8.** *Greater and short saphenous veins.*

**Figure 9.** *Direct continuous and interrupted harvesting method of SVG.*

*Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks DOI: http://dx.doi.org/10.5772/intechopen.88932*

GSV is harvested in two different ways:


*5.4.2 Short saphenous vein*

In rare cases when not enough conduits are available, some surgeons have to use short saphenous vein (**Figure 8**). It can be harvested by positioning the patient in prone or supine position.
