Uterine artery as an arterial conduit for coronary artery bypass graft (CABG) surgery in women: A Role for Estrogen-Receptor Alpha (ER-α) in the Prevention of Post-CABG Accelerated Atherosclerosis and Graft Disease

Coronary artery bypass graft (CABG) surgery is the standard of care in
the treatment of advanced coronary artery disease (CAD). In order to
bypass coronary occlusions, CABG surgery traditionally employs grafts
from the left internal thoracic/mammary artery (LITA/IMA), radial artery
(RA), and greater saphenous vein (SV). The risk of CABG failure is
reported to be higher, or at best similar, for women than for men, and
it relates primarily to post-operative accelerated atherosclerosis
leading to graft stenosis and recurrent angina, a phenomenon known as
“coronary artery bypass graft disease”. In this paper, the authors
hypothesize that employing an alternative arterial conduit may help
reduce the rate of post-CABG accelerated atherosclerosis in women, and
propose that a uterine artery specimen be used instead. Given its
greater density of estrogen-receptor alpha (ER-α) relative to other
mammalian endothelial cells in the vasculature, uterine arteries may
exhibit important anti-atherosclerotic properties. Theoretically, this
effect may be amplified with the adjuvant administration of low-dose
selective ER-α agonist modulator (SERM) therapy.