title: Arterial versus venous bypass grafts in patients with in-stent restenosis.
abstract: BACKGROUND
  In patients who develop in-stent restenosis, successful revascularization can be difficult to achieve using percutaneous methods. This study was designed to verify the surgical results in this setting and to evaluate the potential beneficial role of arterial bypass conduits.
  
  
  RESULTS
  Sixty consecutive coronary artery bypass patients with previous in-stent restenosis and 60 control cases were randomly assigned to receive an arterial conduit (either right internal thoracic or radial artery; study group) or a great saphenous vein graft (control group) on the first obtuse marginal artery to complete the surgical revascularization procedure. At a mean follow-up of 52+/-11 months, patients were reassessed clinically and by angiography. Freedom from clinical and instrumental evidence of ischemia recurrence was found in 19 of 60 subjects in the study group versus 45 of 60 in the control series (P=0.01). The results of the arterial grafts were excellent in both the study and control groups (right internal thoracic artery patency rate, 19 of 20 for both, and radial artery patency rate, 20 of 20 versus 19 of 20; P=0.99). Saphenous vein grafts showed lower patency rate than arterial grafts in both series and had extremely high failure rate in the study group (patency rate, 10 of 20 in the study group versus 18 of 20 in the control group; P=0.001). Use of venous graft was an independent predictor of failure in the study group, whereas hypercholesterolemia was associated with graft failure in both series.
  
  
  CONCLUSIONS
  Venous grafts have an high incidence of failure among cases who previously developed in-stent restenosis, whereas the use of arterial conduits can improve the angiographic and clinical results. Arterial grafts should probably be the first surgical choice in this patient population.
authors.affiliation: Department of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@tiscali.it
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.forename: Carlo
authors.initials: C
authors.lastname: Cellini
authors.forename: Claudio
authors.initials: C
authors.lastname: Pragliola
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Schiavoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.forename: Gianfederico
authors.initials: G
authors.lastname: Possati
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D023903:Coronary Restenosis / Q000601:surgery*; D023921:Coronary Stenosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D012086:Reoperation / Q000379:methods*; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D016042:Transplantation, Heterotopic; D016896:Treatment Outcome; D014654:Vascular Patency