Choosing a vessel for aortocoronary bypass.

In practice, the surgeon is left with few choices of the proper ACB graft. His options are limited entirely to autologous tissues, of which the best is the great saphenous vein from the calf (Table 3). Actually, once leg veins and the internal mammary artery are no longer available there are few other choices worth considering. Small calibre allografts, however preserved, and synthetic grafts, are uniformly doomed to failure. The great saphenous vein from the calf is usually a single tube, of suitable diameter and strength for arterial replacement. Most of its tributaries lie in the upper third of the calf; this makes the lower segment preferable for the patient who requires only one or two bypasses. Variations in the normal anatomy have been illustrated.