Patency of internal thoracic artery compared to vein grafts - postoperative angiographic findings in 1189 symptomatic patients in 12 years.
BACKGROUND
The evidence respecting the superior patency of ITA-grafts compared to SVG is conclusive. This study evaluates the angiographic findings in 1,189 symptomatic patients who received either one or both ITA-grafts with or without additional SVG.


METHODS
1,189 patients (975 males, aged 62.4 +/- 9.1 years), operated between 2/93 and 7/05, underwent angiography due to reappearance of angina. Data were compared for patency of single ITA (n = 618), bilateral ITA (n = 416) or SVG (n = 2,218). Re-catherization was performed after 3.8 +/- 2.7 years. Severe bypass stenosis or graft occlusion was related to the target vessels.


RESULTS
3,668 bypasses were performed in 1189 patients. The occlusion rate was 16.5 % for SVG and 7.0 % for all ITAs ( P < 0.001). Severe stenosis was detected in 4.8 % of SVG and in 3.7 % of ITAs ( P < 0.05). Patency was 89.6 % for LITA, 88.7 % for RITA, and 78.7 % for SVG. The occlusion rate for LITA was: to LAD 6.6 %, DIA 8.5 %, obtuse marginal branch/CX 11.5 %. The occlusion rate for RITA was: to LAD 4.6 %, RCA 9.1 %., diag. branch 7.1 %. The occlusion rate for vein grafts was: to LAD 17.3 %, DIA 14.4 %, obtuse marginal branch/CX 15.9 %, to RCA 17.0 %. Patency for all ITAs was 89.3 % vs.78.7 % for all SVG ( P < 0.05). Despite symptoms, bypass patency was found in 711 patients (59.8 %).


CONCLUSIONS
The superior patency of ITA-grafts could be documented angiographically in a negatively selected, symptomatic population. Graft occlusion was at least twofold higher for SVG.
Gansera
B
B
Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany. brigitte_gansera@web.de
Schmidtler
F
F
Angelis
I
I
Kiask
T
T
Kemkes
B M
BM
Botzenhardt
F
F
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012107:Research Design; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency