Patency of Arterial Versus Venous Grafts in Multisegmental Coronary Artery Disease

Background: Arterial grafts are widely believed to offer superior long-term patency compared with saphenous vein grafts, yet in multisegmental coronary artery disease the diseased runoff bed may attenuate this advantage. In this study, we compared the long-term patency of arterial and venous conduits in patients revascularised for multisegmental coronary artery disease. Methods: We retrospectively analysed 467 bypass grafts (100 arterial internal thoracic artery grafts, 351 saphenous vein grafts and 16 radial artery grafts) in 133 patients with multisegmental coronary artery disease treated by coronary artery bypass grafting, including long anastomoses where required. Graft patency was assessed by multidetector computed tomography or coronary angiography. Patency over time was estimated by the Kaplan-Meier method and compared with the log-rank test. Because imaging was symptom-driven rather than protocol-based, patency estimates apply to the imaged subgroup. Results: Early patency was comparably high for arterial (97%) and venous (96%) conduits. Patency curves diverged progressively: at 12 years, estimated patency was 83% for arterial grafts versus 65% for venous grafts (p < 0.01). Radial artery grafts maintained 87% patency over the available follow-up. Conclusions: These findings suggest that the long-term patency advantage of arterial conduits may be preserved in patients with multisegmental coronary artery disease, including where long anastomoses are required, and warrant confirmation in larger cohorts with systematic imaging follow-up.