Arterial Grafting and Complete Revascularization: Challenge or Compromise?

PURPOSE OF REVIEW:

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.

RECENT FINDINGS:

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.

CONCLUSION:

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.