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La derivación coronaria es una cirugía a corazón abierto (se abre el tórax, pero no el corazón) que se realiza a través de una apertura en la parte ósea de la cavidad torácica. Mientras un cirujano opera en el tórax, otro toma una porción de la vena safena para la derivación mediante una amplia incisión a lo largo de la cara interna de la parte inferior de la pierna. La vena se cose por arriba y por abajo del bloqueo de la arteria coronaria. Como alternativa, se usa una arteria de la cara interna de la pared torácica (arteria mamaria interna) o del brazo (arteria radial).

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