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Pre-existing vascular disease in the radial artery and other coronary artery bypass conduits
S M Kane-ToddHall1, S P Taggart, H Clements-Jewery
1University of Oxford Nuffield Department of Pathology and Bacteriology,England.
Insights
The radial artery (RA) shows mild intimal thickening, medial sclerosis, and calcification more often than internal mammary artery (IMA) or long saphenous vein (LSV) grafts. Further research is needed to understand how this impacts coronary artery bypass graft (CABG) patency.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Graft Patency Studies
Background:
- Growing interest in using the radial artery (RA) for coronary artery bypass grafting (CABG).
- Limited data exists on the prevalence of pre-existing disease within the radial artery.
- Understanding vessel health is crucial for selecting optimal CABG conduits.
Purpose of the Study:
- To compare the prevalence of pre-existing atherosclerotic disease in radial arteries (RA) versus internal mammary arteries (IMA) and long saphenous veins (LSV).
- To assess histological characteristics of potential CABG conduits.
- To evaluate the suitability of RA as a CABG graft based on vessel pathology.
Main Methods:
- Histological analysis of 177 RAs, 168 IMAs, and 86 LSVs from patients undergoing CABG.
- Assessment of stenosis, active atheroma, intimal thickening, and medial hyaline sclerosis.
- Comparative analysis of disease prevalence across the three vessel types.
Main Results:
- Over 98% of RAs, IMAs, and LSVs showed less than 30% stenosis.
- Significant differences in mild disease prevalence: RAs had higher rates of intimal thickening (42%), medial sclerosis (46%), and medial calcification (9%) compared to IMA and LSV.
- No severe stenosis was found in any conduit type.
Conclusions:
- The majority of CABG conduits (RA, IMA, LSV) exhibit minimal severe disease.
- Radial arteries demonstrate a higher prevalence of mild intimal thickening, medial sclerosis, and calcification compared to IMA and LSV.
- The long-term implications of these findings on radial artery graft patency in CABG remain uncertain and require further investigation.
Background:
There is increasing interest in the radial artery (RA) as a coronary artery bypass graft (CABG). However, few studies have examined the prevalence of pre-existing disease in this vessel.
Methods:
Histological specimens from 177 RA were compared with 168 of internal mammary artery (IMA) and 86 of long saphenous vein (LSV) from the same patients undergoing CABG. The degree of stenosis, active atheroma, intimal thickening, and medial hyaline sclerosis was assessed. -
Results:
99% of IMAs, 98% of RAs and 100% of SVs had less than 30% stenosis. 91% of IMAs, 42% of RAs and 70% of SVs had less than 5% stenosis. Medial sclerosis was present in 10% of IMAs, 36% of LSVs and 46% of RAs. Medial calcification was present in 9% of RAs, 1% of LSVs and not in IMAs.
Conclusion:
The majority of conduits did not have evidence of severe disease. There is an increased prevalence of mild intimal thickening, medial sclerosis and medial calcification in RAs compared with IMAs and LSVs. The implications for longer-term graft patency are uncertain.