Arterial grafting and complete revascularization: challenge or compromise?
OBJECTIVE
Arterial grafting is superior to venous grafting in coronary artery bypass graft surgery with respect to graft patency and long-term patient outcome, but it may be difficult to achieve complete arterial revascularization.


RESULTS
Use of arterial grafts, especially bilateral internal mammary artery grafts, is not common, whereas there are clear indications that it may increase survival. Definitions of complete revascularization are varied and confusing, making study comparisons difficult. Technical challenges in complete revascularization with arterial grafts can be minimized by surgical techniques. Competitive flow in moderately stenosed coronary arteries grafted with arterial conduits may result in reduced patency. While internal mammary arteries may be used in arteries with at least 60% stenosis, radial artery and gastroepiploic grafts are best placed onto coronaries with severe stenosis. Moderate lesions in the left coronary circulation should be bypassed, but right coronary artery lesions can be left untouched as there is minimal progression over time. Complete revascularization may not be necessary or possible in every patient because of technical challenges.


CONCLUSIONS
Complete revascularization with arterial grafts presents both technical and physiological challenges. However, with techniques to maximize length of arterial conduits, knowledge of competitive flow and which moderate lesions should be addressed, complete revascularization with arterial grafts can be accomplished in the majority of patients, notwithstanding it may not be possible or even indicated for every patient.
aDepartment of Cardiac Sciences, LIBIN Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada bDepartment of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Teresa M
TM
Kieser
Stuart J
SJ
Head
A Pieter
AP
Kappetein
D001158:Arteries / Q000637:transplantation*; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000601:surgery*; D024405:Gastroepiploic Artery / Q000637:transplantation; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D008323:Mammary Arteries / Q000637:transplantation; D009204:Myocardial Revascularization / Q000379:methods*; D017534:Radial Artery / Q000637:transplantation; D016896:Treatment Outcome; D014654:Vascular Patency