[Arterial revascularization of coronary vessels]

ARTERIAL GRAFTS: Atherosclerosis is the major cause of late vein graft failure and has led to the use of arterial grafts. The use of the left internal thoracic artery (ITA) is associated with improved survival which has been proven in numerous studies. Recent studies have also demonstrated a survival benefit of double over single ITA graft use. Especially in younger patients bilateral ITA grafting is recommended.

In terms of dissection of the graft, the technique of skeletizing the artery seems beneficial especially in diabetics to decrease the likelihood of mediastinitis. The radial artery is mainly used as a T graft in order to achieve complete arterial revascularization.

While patency rates seem superior as compared to vein grafts, a survival benefit has yet to be proven. Irrespective of graft type, in-situ-grafts have a superior patency as opposed to free grafts. As has long been demonstrated with vein grafts, patency of arterial grafts also depends on the size of the recipient vessel. Grafts to the distal circumflex and distal right coronary artery have worse patency rates than grafts to the LAD. Conflicting results exist concerning the gastroepiploic artery; its use can only be recommended if the vessel is of good caliber. All other arterial conduits are used infrequently and there are no data to draw any meaningful conclusion for routine use. Arterial revascularization on the beating heart is feasible and short and midterm follow-up data are encouraging.

Our current policy is to perform complete arterial revascularization in all patients under the age of 70 using bilateral ITAs and radial arteries.