Arterial grafts for coronary artery surgery

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.