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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Saphenous vein as a composite graft from the internal thoracic artery
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Insights
Coronary artery bypass grafting using the saphenous vein shows lower patency than the internal thoracic artery. A new strategy explores using the saphenous vein within a composite arterial graft for better outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting (CABG)
Background:
- Saphenous vein (SV) grafts in CABG have historically shown lower long-term patency and clinical outcomes compared to internal thoracic artery (ITA) grafts.
- The effectiveness of ITA in CABG has driven interest in total arterial revascularization using composite grafts for multi-vessel disease.
Discussion:
- Total arterial revascularization with Y- or T-composite grafts based on the in situ ITA offers extended arterial graft length, enabling revascularization of both coronary territories.
- This approach has demonstrated improved angiographic patency, myocardial perfusion, and long-term clinical outcomes.
Key Insights:
- Conflicting results exist regarding the use of SV as a composite graft component.
- This article discusses a recent surgical strategy integrating the SV into a composite graft anchored by the in situ left ITA.
Outlook:
- Further research is needed to clarify the role and optimal use of SV within composite arterial grafts.
- Investigating the long-term efficacy and safety of this specific SV-ITA composite grafting strategy is crucial.
Abstract:
The saphenous vein (SV) has been used as an aortocoronary bypass graft for coronary artery bypass grafting (CABG) for the past 50 years. However, CABG using the aortocoronary SV has shown disadvantages of lower long-term graft patency rates and subsequently worse clinical outcomes, compared with CABG using the internal thoracic artery (ITA). The advantages of CABG using the ITA prompted interest in total arterial revascularization, using the bilateral ITAs and other arterial conduits as composite graft configurations in patients exhibiting multi-vessel disease. Total arterial revascularization using a Y- or T-composite graft based on the in situ ITA increases the length of the arterial graft and allows the extensive use of arterial conduits to revascularize both the left and right coronary territories. Further, it has demonstrated favorable outcomes in terms of angiographic patency rates, myocardial perfusion and thickening by single photon emission computed tomography, and long-term clinical outcomes. However, previous studies describing the use of the SV conduit as a composite graft have produced conflicting results. In this article, a recent surgical strategy of using the SV as part of a composite graft based on the in situ left ITA will be discussed.
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