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Arterial grafts for coronary artery surgery
W Wandschneider1, P Wurnig, S Redtenbacher
1I. Surgical Department for Cardiovascular Surgery, General Hospital Lainz, Vienna, Austria.
Insights
The inferior epigastric artery is the best choice for coronary artery bypass grafting due to fewer atherosclerotic changes. The gastroepiploic artery and inferior epigastric artery may serve as additional grafts for all-arterial grafting.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Grafting Techniques
Background:
- Coronary artery bypass grafting (CABG) frequently utilizes arterial grafts.
- Selection of optimal arterial conduits is crucial for long-term graft patency.
- Internal mammary artery, gastroepiploic artery, and inferior epigastric artery are commonly considered for CABG.
Purpose of the Study:
- To compare the length, diameter, and prevalence of atherosclerotic changes among left internal mammary artery (LIMA), right gastroepiploic artery (RGEA), and right inferior epigastric artery (RIEA).
- To determine the suitability of these arteries as grafts for coronary artery bypass grafting.
- To provide evidence-based recommendations for arterial graft selection in CABG procedures.
Main Methods:
- Fifty specimens of LIMA, RGEA, and RIEA were harvested.
- Vascular dimensions (length and diameter) were measured.
- Histological examination was performed to assess the frequency and severity of atherosclerotic plaques.
Main Results:
- Mean usable lengths were 132.4 mm (LIMA), 127.9 mm (RGEA), and 128.4 mm (RIEA).
- One RGEA specimen was found to be occluded.
- Atherosclerotic plaques were identified in 14% of LIMA, 24% of RGEA, and 28% of RIEA specimens.
Conclusions:
- The inferior epigastric artery demonstrates a lower incidence of atherosclerotic changes compared to the gastroepiploic artery and internal mammary artery.
- The RIEA is recommended as the primary arterial graft of choice for CABG.
- RGEA and RIEA can be considered as supplementary grafts when an all-arterial grafting strategy is pursued.
Abstract:
Fifty specimens of left internal mammary artery, right gastroepiploic artery and right inferior epigastric artery were examined for length, diameter and frequency of atherosclerotic changes. Mean usable length was 132.4 mm for internal mammary arteries, 127.9 mm for gastroepiploic arteries and 128.4 mm for inferior epigastric arteries. One gastroepiploic artery was occluded. Histological examination revealed atherosclerotic plaques in seven internal mammary arteries (14%), 12 gastroepiploic arteries (24%) and 14 inferior epigastric arteries (28%). These findings emphasize the superiority of the inferior epigastric artery as the graft of choice for coronary artery bypass grafting. Gastroepiploic artery and inferior epigastric artery should only be used as additional grafts if 'all-arterial-grafting' is intended.