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• W2000494090 abstract "It has become increasingly clear that the long-term patency of internal mammary artery (IMA) grafts is superior to that of grafts from saphenous vein [l-31. Although there are some technical difficulties in the use of IMA grafts because of their limited length and sometimes small diameter, it has been shown that they may be used as free grafts [ l , 3,4], and there is good evidence that they can supply sufficient blood for most myocardial revascularization procedures [4]. The article by Landymore and Chapman in this issue of The Annuls (p 4) provides further evidence of the usefulness and versatility of IMA grafts and of the use of this vessel as a free graft. Extensive surgical experience of graft behavior over the last twenty years has raised fascinating questions about the basic pathology of arteries and veins. Why is the IMA relatively protected in the body, and why does this relative immunity to intimal thickening continue when the vessel is used as a graft? Why do other arteries, particularly the coronary arteries, show substantial intimal thickening at an early age and continue to undergo increasing intimal thickening throughout life? What is the reason for the accelerated intimal thickening of vein grafts? Although it cannot be suggested that definitive explanations can be offered at present, the accumulated evidence of a large amount of work in vascular pathology now provides a much clearer understanding of the mechanism of intimal thickening, and at least firstapproximation answers to these important questions. It has been established for a considerable time that the earliest stage of intimal thickening in vessels such as the coronary arteries that develop early arterial disease is a growth of smooth muscle cells from the media into the intimal compartment [ 5 ] . Even during the first decade of life, the striking histological feature of these arteries is the presence of discontinuities in the internal elastic lamina through which medial cells populate the intima. The IMA, alternatively, has an internal elastic lamina that is almost perfectly formed in the younger age groups. It shows no evidence of discontinuities containing smooth muscle cells from the media, and the intimal compartment consists only of scanty matrix covered by endothelium, which lies in close approximation to the internal elastic lamina. Such observations suggest that the internal elastic lamina has a key role in arterial wall structure [6]. They suggest that if there are gross deficiencies of the internal elastic lamina, there will be early and progressive intimal" @default.
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• W2000494090 date "1987-07-01" @default.
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• W2000494090 title "The Internal Mammary Artery as a Bypass Graft?" @default.
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• W2000494090 doi "https://doi.org/10.1016/s0003-4975(10)62341-7" @default.
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