What is the average lifespan of an artery graft?

Artery Graft Longevity in Coronary Artery Bypass Grafting

Internal mammary artery (IMA) grafts demonstrate superior longevity with 85-90% patency at 10 years and maintain 94% patency even at 7-9 years, making them the gold standard conduit for coronary artery bypass grafting. 1, 2

Internal Mammary Artery Graft Patency

The left internal mammary artery (LIMA) to the left anterior descending artery represents the most durable graft configuration available, with the following patency rates:

• >90% patency at 10-15 years 3, 4
• 88% patency at 10 years if patent at 1 week post-operatively 1
• 94.4% patency at 60-108 months (5-9 years) with minimal atherosclerosis 2
• 85% overall patency at 10 years 1

The European Heart Journal guidelines emphasize that arterial grafting to the LAD system is a Class I, Level A recommendation, reflecting the strongest possible evidence for this approach 5.

Radial Artery Graft Patency

Radial artery grafts serve as the preferred second arterial conduit, demonstrating intermediate longevity:

• 89% patency at 4-5 years 4
• 79.25% patency at approximately 11.5 years 6
• Superior to saphenous vein grafts at 5 years 5

The American College of Cardiology recommends radial artery as the preferred second conduit over saphenous vein grafts (Class I, Level B-R) 4. However, the radial artery should target vessels with >70% stenosis for left-sided coronary arteries or >90% stenosis for right-sided arteries to ensure optimal patency 4.

Saphenous Vein Graft Patency

Saphenous vein grafts demonstrate significantly inferior longevity compared to arterial conduits, with progressive deterioration over time:

Early and Mid-Term Patency

• 88% patency early post-operatively 7
• 81% patency at 1 year 7, 8
• 75% patency at 5 years 7
• 68% patency at 10 years if patent at 1 week 1

Long-Term Patency

• 61% overall patency at 10 years 1
• 50% patency at ≥15 years 7
• Only 25-50% patency at 10-15 years 3, 4
• Of grafts patent at 15+ years, only 40% are excellent quality (grade A) and 44% have >50% stenosis 7

Attrition Rates

• 10-25% occlusion within the first year 3
• 2.1% annual occlusion rate after the early period 7
• 1-2% annual occlusion during years 1-5 3
• 4-5% annual occlusion during years 6-10 3

Disease Progression

• Vein graft disease appears by 1 year and accelerates after 2.5 years 7
• 48% of grafts show disease at 5 years 7
• 81% of grafts show disease at ≥15 years 7
• Only 50-60% of patent SVGs at 10 years are free of atherosclerosis 3

Factors Affecting Graft Longevity

Target Vessel Characteristics

Recipient vessel size critically impacts graft survival:

• Vessels >2.0 mm diameter: 88% SVG patency 1
• Vessels ≤1.5 mm diameter: significantly reduced patency with occlusion odds ratio of 2.63 for SVGs and 2.31 for arterial grafts 6

Target vessel stenosis severity affects arterial graft patency:

• Arterial grafts to vessels with <90% stenosis have 3.02 times higher occlusion risk 6
• SVG patency to LAD (69%) exceeds patency to RCA (56%) or circumflex (58%) 1

Competitive Flow

Competitive flow from native coronary circulation causes graft failure, particularly affecting LIMA-LAD grafts where 7 of 13 occlusions (54%) were attributed to this mechanism 6.

Clinical Implications for Graft Selection

Complete arterial revascularization should be strongly pursued in younger patients (≤60 years) with few comorbidities, as bilateral IMA grafting provides survival advantage 5, 4. The European Heart Journal reports that bilateral IMA grafting is associated with reduced mortality (HR 0.81,95% CI: 0.70-0.94) 5.

For patients requiring multiple grafts beyond available arterial options, saphenous vein grafts remain necessary but should be used with full understanding of their limited durability 3. The high failure rate of venous grafts—with 10-26% occlusion between 12-18 months when used for distal targets—underscores the importance of arterial conduit prioritization 5, 9.

Critical Pitfalls

Avoid endoscopic vein graft harvesting, as this technique has been associated with vein graft failure and adverse clinical outcomes 9, 4. Do not bypass vessels with inadequate stenosis severity, as competitive flow promotes graft failure 3. Ensure precise surgical technique in IMA preparation and anastomosis, as this is essential for long-term patency 2.