Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting?
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Case Presentation: Mr P is a 57-year-old construction worker who has had Canadian Cardiovascular Society class III angina for the past 3 months. He has multiple cardiovascular risk factors including smoking, hypertension, dyslipidemia, and diabetes. He is obese and has had a previous laparotomy for a perforated bowel. Coronary angiography revealed triple vessel disease involving the left anterior descending artery (LAD), the first obtuse marginal branch, and the right coronary artery (RCA), and an akinetic inferior wall with an estimated ejection fraction of 40%. The patient was referred for consideration of coronary artery bypass graft (CABG) surgery. Is Mr P a candidate for CABG and, if so, which vascular conduits should be used?
CABG is the standard surgical procedure for the treatment of advanced coronary artery disease. Since the first successful results reported by Favaloro,1 CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life.2 Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Five to 7 years after surgery, patients are at increased risk of suffering from ischemic complications coincident with graft failure.2 Furthermore, as patients undergoing CABG surgery become older with more preoperative risk factors, and treated patients are living longer and therefore requiring reoperation, the optimal selection of vascular grafts for bypass is essential.
Conduits Used in Bypass Surgery
Conventional CABG surgery utilizes a combination of arterial and venous grafts. Saphenous vein (SV) grafts, the first vascular conduits used in CABG, are still widely utilized, primarily to bypass vessels other than the LAD. Despite being readily accessible, of adequate length to access every vessel on the heart, and the correct diameter to facilitate coronary and aortic anastomoses, SV grafts are limited by poor long-term patency. Because of a combination …