Abstract
Objectives: The aim of this study was to evaluate the performance and the quality of arterial grafts for coronary artery bypass grafting at The Heart Institute of Japan, Tokyo Women’s Medical University.Patients and Methods: From January 1970 to March 1998, 2987 arterial grafts, including left and right internal thoracic arteries, gastroepiploic artery, radial artery and inferior epigastric artery, were used in 1673 patients. In the same period, 1225 saphenous vein grafts were used. Early graft patency was angiographically determined. Also, histological evaluation of operative specimens and preoperative angiographic evaluation of arterial grafts were performed.Results: The total number of hospital deaths was 38 (2.3%). Of 4212 grafts, 3919 grafts (93%) were evaluated angiographically and 3714 of 3919 grafts were patent (94.8%). The patency rate of internal thoracic artery was better than that of gastroepiploic artery (p < 0.0001), radial artery (p = 0.0005) and saphenous vein grafts (p < 0.0001). However, the patency rate of gastroepiploic artery was better than that of saphenous vein grafts (p = 0.04), while no significant difference was detected between gastroepiploic artery and rdial artery. Only one internal thoracic artery specimen obtained at surgery showed atherosclerotic change, but all gastroepiploic artery specimens had moderate to severe atherosclerotic changes with CD68-positive cell infiltration. Only one patient’s left internal thoracic artery out of 200 was not angiographically useable as a conduit, while multiple stenotic lesions in gastroepiploic artery were observed.Conclusions: In the graft selection for CABG, the primary choice is internal thoracic artery and the secondary choice is right internal thoracic artery, from the standpoint of histological and angiographic evaluation, gastroepiploic artery and/or radial artery, depending on the target anastomotic site, degree of stenosis, and in situ or free use is the third choice.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the intemal-mammary-artery graft on 10-year survival and other cardiac events, N Engl J Med, 1986; 314: 1–6.
Tatsumi TO, Tanaka Y, Kondoh K, Minohara S, Sawada Y, Tsuchida T, et al. Descending branch of lateral femoral circumflex artery as a free graft for myocardial revascularization: a case report. J Thorac Cardiovasc Surg 1996; 112: 546–7.
Mills NL. Arterial grafts for coronary artery bypass, Adv Cardiac Surg 1997; 9: 195–216.
Carpentier A, Guermonprez JL, Deloche A, Frechette C, DuBost C. The aorta-to-coronary radial artery bypass graft. Ann Thorac Surg 1973; 16: 111–21.
Acar C, Jebara VA, Portoghese M, Beyssen B, Pagny JY, Grare P, et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992; 54: 652–60.
Mills NL, Everson CT. Vein graft failure. Curr Opin Cardiol 1995; 10: 562–8.
van Son JA, Smedts F, Vincent JG, van Lier HJ, Kubat K: Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 1990; 99: 703–7.
Buxton B, Windsor M, Komeda M, Gaer J, Fuller J, Liu J. How good is the radial artery as a bypass graft. Coron Artery Dise 1997; 8: 225–33.
Calafiore AM, Teodori G, Di Giammarco G, D’Annunzio E, Angelini R, Vitolla G, et al. Coronary revascularization with the radial artery; new interest for an old conduit. J Card Surg 1995; 10: 140–6.
Suma H, Amano A, Horii T, Kigawa I, Fukuda S, Wanibuchi Y. Gastroepiploic artery graft in 400 patients. Eur J Cardiothorac Surg 1996; 10: 6–11.
Curtis JJ, Stoney WS, Alford WC, Burrus GR, Thomas CS. Intimai hyperplasia: a cause of radial artery aortocoronary bypass graft failure. Ann Thorac Surg 1975; 20: 628–35.
Author information
Authors and Affiliations
Additional information
Read at the Fifty-first Annual Meeting of The Japanese Association for Thoracic Surgery, Panel Discussion, Tokyo, October 2–4, 1998.
Rights and permissions
About this article
Cite this article
Tomizawa, Y., Endo, M., Nishida, H. et al. Use of arterial grafts for coronary revascularization. Jpn J Thorac Caridovasc Surg 47, 325–329 (1999). https://doi.org/10.1007/BF03218019
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03218019