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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Cardiothoracic Surgery

Advisor

Elyse Watkins

Abstract

Purpose

The purpose of this review article is to explore the conduit options for coronary artery bypass grafting (CABG) and discuss the long-term patency of arterial conduits versus vein grafts to determine which is superior.

Methods

A literature search was conducted to compare the use of arterial conduits with saphenous vein grafts for CABG to determine which was superior in regards to long-term patency. The search looked at high quality, randomized controlled trials and systematic reviews of multiple high quality, randomized controlled trials. Limitations included limited long-term data greater than ten years and limited randomized controlled trials. Databases searched included PubMed, the Cochrane Library, and MEDLINE. The filters used included adults, clinical trials, randomized clinical trials, studies published within the last ten years, and full text. Terms used to guide the search strategy included CABG, arterial conduits, internal mammary artery, radial artery conduits, saphenous vein grafts, and long-term patency. The PubMed search yielded 15 pertinent articles, the Cochrane Library search yielded 14 pertinent articles, and the MEDLINE search yielded three pertinent articles.

Results

Multiple studies have shown the superiority of arterial conduits over saphenous vein grafts for CABG, particularly when using the radial artery conduit as the second conduit in addition to the left or right internal mammary artery.

Conclusion

Improved long-term patency and survival has been shown when using the radial artery as a second conduit in addition to the left internal mammary artery (LIMA) compared to the saphenous vein graft.1 However, Benedetto and Codispoti found that the survival benefit and protection against late death when using a radial artery conduit decreases as patients reach age 70.1 The Society of Thoracic Surgeons (STS) clinical practice guidelines on the use of arterial conduits for CABG state that the LIMA should be used for bypassing the left anterior descending artery (class I recommendation) and a second arterial graft (either the right internal mammary artery or radial artery) should be considered as an adjunct to the LIMA in appropriate patients (class IIa recommendation).2 The STS guidelines also state that the use of bilateral internal mammary arteries should be considered in patients who do not have an excessive risk of sternal complications (class IIa recommendations). 2 Radial artery conduits are not widely used as the benefits have mostly been shown in observational studies but not confirmed in randomized clinical trials.3 Largely it does appear that they offer a benefit to the appropriate patient, however, more trials need to be conducted and long-term data thus far has been insufficient.

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