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Published on: November 19, 2019
Long-term patency rate for radial artery vs. saphenous vein grafts using same-patient materials
Mitsumasa Hata1, Isamu Yoshitake, Shinji Wakui
1Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan. mihata@med.nihon-u.ne.jp
Insights
Long-term graft patency for radial artery (RA) and saphenous vein (SV) used in coronary artery bypass grafting showed similar 8-year results. RA showed poorer outcomes in patients with specific conditions, highlighting the need for tailored treatment strategies.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting (CABG)
Background:
- Radial artery (RA) and saphenous vein (SV) are commonly used conduits in CABG.
- Assessing long-term patency differences between RA and SV is crucial for surgical decision-making.
Purpose of the Study:
- To compare the long-term graft patency rates of the radial artery (RA) versus the saphenous vein (SV).
- To identify independent predictors of graft failure for both RA and SV in patients undergoing CABG.
Main Methods:
- A cohort of 318 patients undergoing CABG using both RA and SV was followed for 8 years.
- Graft patency was assessed via angiography or multi-slice computed tomography in 192 patients.
- Statistical analysis identified predictors of graft failure for each vessel type.
Main Results:
- At 8 years, cumulative graft patency was 74.3% for RA and 64.7% for SV, with no significant difference.
- Predictors of RA graft failure included native coronary stenosis <75% and peripheral vascular disease (PVD).
- Predictors of SV graft failure included use of a single anti-platelet agent and a high LDL/HDL ratio (>2.5).
Conclusions:
- Radial artery and saphenous vein grafts demonstrate similar long-term patency rates at 8 years post-CABG.
- Radial artery grafts performed less favorably in patients with target vessel stenosis <75% and co-existing PVD.
- Optimizing anti-platelet therapy and lipid management may enhance long-term saphenous vein graft patency.
Background:
The aim of the present study was to assess the long-term graft patency rate of the radial artery (RA), in comparison to the saphenous vein (SV) in patients harvested for both vessels.
Methods And Results:
RA and SV were concomitantly used for coronary artery bypass grafting in 318 patients in an 8-year period from January 2002 to March 2010. During follow-up, graft patency was assessed on angiography or multi-slice computed tomography in 192 of these patients. Cumulative graft patency rates were compared between RA and SV. Independent predictors for graft failure were examined for both vessels. Cumulative graft patency rates at 8 years were 74.3% in RA and 64.7% in SV, respectively. There was no significant difference between these types of grafts. Independent predictors of late RA graft failure were native coronary stenosis <75% and peripheral vascular disease (PVD). Independent predictors of late SV graft failure were use of only one anti-platelet agent and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio >2.5. Cardiovascular event-free and actuarial survival rates at 8 years in this series were 81.2% and 89.7%, respectively.
Conclusions:
Cumulative graft patency rates between RA and SV were similar at 8 years. RA performed more poorly in patients with target vessel stenosis <75% and in those complicated by PVD. Aggressive anti-platelet therapy and strict lipid control may be important in maintaining long-term patency of SV.
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