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Internal mammary artery versus saphenous vein graft. Comparative performance in patients with combined
Insights
Internal mammary artery grafts show superior long-term patency compared to saphenous vein grafts in coronary artery disease patients. Saphenous vein graft failure is the primary cause of late symptoms after combined revascularization.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafts
- Coronary Artery Disease
Background:
- Coronary artery disease (CAD) management often involves surgical revascularization.
- Combined grafting using internal mammary artery (IMA) and saphenous vein (SV) grafts is a common surgical approach.
- Long-term graft patency is crucial for sustained clinical benefit.
Purpose of the Study:
- To evaluate the long-term performance and patency of internal mammary artery (IMA) and saphenous vein (SV) grafts.
- To identify the primary cause of graft failure and symptom development in patients undergoing combined myocardial revascularization.
- To compare the durability of IMA versus SV grafts up to 10 years post-surgery.
Main Methods:
- Retrospective angiographic study of 33 patients with CAD.
- Patients underwent combined myocardial revascularization with at least one IMA and one or more SV grafts.
- Angiographic assessment of graft patency and condition performed up to 10 years post-operation.
Main Results:
- Internal mammary artery (IMA) grafts demonstrated significantly superior long-term patency compared to saphenous vein (SV) grafts.
- Saphenous vein graft failure (occlusion or severe stenosis) was the predominant cause of late symptoms, affecting 74% of SV grafts in symptomatic patients.
- IMA grafts remained patent in 15 out of 16 grafts in the late symptomatic group, with only one occlusion.
Conclusions:
- Internal mammary artery grafts offer superior long-term durability and patency in combined myocardial revascularization procedures.
- Saphenous vein graft failure is a major contributor to late symptom recurrence in patients undergoing combined revascularization.
- IMA grafts should be prioritized for coronary artery bypass grafting due to their better long-term outcomes.
Abstract:
Thirty three patients with coronary artery disease undergoing combined myocardial revascularisation with internal mammary artery and saphenous vein grafts underwent angiographic studies up to 10 years after operation. Each patient had one internal mammary artery graft and one or more saphenous vein grafts. Eleven symptom-free patients, studies one month to five years (mean 1.9 years) after operation, had intact internal mammary artery and saphenous vein grafts in a good state of preservation. Of the six patients developing symptoms within the first year after surgery, three had evidence of poor flow in the internal mammary artery graft because of large side branches and the other three had stenosis or occlusion of the saphenous vein grafts. Sixteen patients developed symptoms after several years free of symptoms and were studied three to 10 years (mean six years) after operation. Of the 23 saphenous vein grafts in this group, 17 (74%) were either occluded or severely stenosed and six (26%) were in good condition. One internal mammary artery graft was occluded and the remaining 15 were in good condition. Saphenous vein graft failure was the predominant cause of late development of symptoms in patients with combined revascularisation. Long term performance of the internal mammary artery grafts is far superior to the saphenous vein grafts.