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Updated: Jul 6, 2026
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts
Nimesh D Desai1, Eric A Cohen, C David Naylor
1Division of Cardiac Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada.
Insights
Radial artery grafts show lower occlusion rates than saphenous vein grafts in coronary bypass surgery. Radial artery graft use should prioritize vessels with high-grade stenosis for optimal patency.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Clinical Trials
Background:
- Radial artery grafts are increasingly used in coronary bypass surgery.
- Concerns exist regarding potential graft spasm and long-term patency.
- Graft patency is crucial for patient survival after bypass surgery.
Purpose of the Study:
- To compare the patency rates of radial artery grafts versus saphenous vein grafts.
- To evaluate graft occlusion in a randomized trial controlling for patient and vessel selection bias.
Main Methods:
- A randomized trial involving 561 patients across 13 centers.
- Radial artery grafts were randomly assigned to bypass specific coronary territories.
- Saphenous vein grafts served as controls for the opposing territory.
- Graft occlusion was assessed via angiography 8-12 months postoperatively.
Main Results:
- At one year, radial artery grafts had significantly lower complete occlusion rates (8.2%) compared to saphenous vein grafts (13.6%).
- Diffuse narrowing ('string sign') was more frequent in radial artery grafts (7.0%) than saphenous vein grafts (0.9%).
- Radial artery graft occlusion and narrowing were associated with less severe native-vessel stenosis.
Conclusions:
- Radial artery grafts demonstrate superior patency rates at one year compared to saphenous vein grafts.
- The patency of radial artery grafts is influenced by the severity of native-vessel stenosis.
- Preferential use of radial artery grafts for target vessels with high-grade lesions is recommended.
Background:
In the past decade, the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a randomized trial in which we controlled for bias in the selection of patients and vessels.
Methods:
We enrolled 561 patients at 13 centers. The left internal thoracic artery was used to bypass the anterior circulation. The radial-artery graft was randomly assigned to bypass the major vessel in either the inferior (right coronary) territory or the lateral (circumflex) territory, with the saphenous-vein graft used for the opposing territory (control). The primary end point was graft occlusion, determined by angiography 8 to 12 months postoperatively.
Results:
Angiography was performed at one year in 440 patients: 8.2 percent of radial-artery grafts and 13.6 percent of saphenous-vein grafts were completely occluded (P=0.009). Diffuse narrowing of the graft (the angiographic "string sign") was present in 7.0 percent of radial-artery grafts and only 0.9 percent of saphenous-vein grafts (P=0.001). The absence of severe native-vessel stenosis was associated with an increased risk of occlusion of the radial-artery graft and diffuse narrowing of the graft. Harvesting of the radial artery was well tolerated.
Conclusions:
Radial-artery grafts are associated with a lower rate of graft occlusion at one year than are saphenous-vein grafts. Because the patency of radial-artery grafts depends on the severity of native-vessel stenosis, such grafts should preferentially be used for target vessels with high-grade lesions.
