From the Guidelines
Total arterial grafting is preferred over venous grafting in coronary artery bypass grafting (CABG) due to its superior long-term patency rates and reduced risk of recurrent angina or myocardial infarction, as evidenced by the use of arterial grafts, specifically the internal thoracic artery (ITA) 1. The main difference between total arterial and venous graft CABG lies in the type of graft used, with arterial grafts offering better resistance to atherosclerosis and higher patency rates compared to venous grafts. Some key points to consider when deciding between total arterial and venous grafting include:
- The use of bilateral ITA is associated with higher post-operative sternal dehiscence and increased rate of mediastinitis in obese and possibly diabetic patients, but also correlates with event-free long-term survival and reduced risk of recurrent angina or MI 1.
- The radial artery graft has patency rates possibly superior to saphenous grafts at 5 years, and can be used to increase the number of arterial anastomoses beyond the use of both ITAs 1.
- The side-to-side anastomosis used in arterial and venous grafting eliminates an aortic anastomosis, decreases the amount of graft required, and increases total graft flow, contributing to a higher patency rate 1. The decision between total arterial and venous grafting should be individualized based on patient factors, coronary anatomy, and surgeon experience, taking into account the potential benefits and risks of each approach. In terms of specific grafts, the ITA is the preferred choice, with the radial artery and gastroepiploic artery also being viable options, while saphenous vein grafts (SVGs) typically show higher failure rates compared to arterial grafts 1.
From the Research
Difference between Total Arterial and Venous Graft CABG
The main difference between total arterial and venous graft Coronary Artery Bypass Grafting (CABG) lies in the type of graft used to bypass the blocked coronary artery.
- Total arterial graft CABG uses only arterial grafts, such as the left internal thoracic artery (LITA) and radial artery, to bypass all blocked coronary arteries.
- Venous graft CABG, on the other hand, uses a combination of arterial and venous grafts, with the greater saphenous vein being the most commonly used venous graft.
Outcomes of Total Arterial Graft CABG
Studies have shown that total arterial graft CABG is associated with superior short-term and long-term outcomes compared to venous graft CABG 2, 3, 4.
- Total arterial graft CABG has been shown to have higher long-term patency rates and lower rates of graft occlusion compared to venous graft CABG.
- Additionally, total arterial graft CABG has been associated with improved survival rates and reduced risk of myocardial infarction and re-intervention.
Comparison of Arterial and Venous Grafts
A meta-analysis comparing the long-term patency and clinical outcomes of arterial and venous grafts used in CABG found no significant difference between the two types of grafts in terms of long-term patency, overall mortality, and rate of revascularization 5.
- However, other studies have suggested that the use of arterial grafts, particularly the LITA and radial artery, is associated with superior long-term outcomes compared to venous grafts 2, 3, 4.
Current Status and Future Directions
The current status of CABG suggests that total arterial graft CABG is a highly efficient technique that can be used to reliably revascularize all coronary artery territories 2.