CABG

Posted By  CCF Cardio MD SK on December 29, 1997 at 15:27:06:

In Reply to: CABG posted by Ken on December 22, 1997 at 15:42:14:

: What factors determine the use of an artery from the arm instead of a vein
  from the leg as a graft for CABG?

[CCF CARDIO MD SK]

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Dear Ken,
The artery in the arm that is used for coronary artery bypass surgery is called the radial artery. Over last three decades, it has become clear that the success rate of internal mammary artery graft is higher than that of vein grafts leg. This led us to a hypothesis that arterial grafts would do better than vein grafts on a longer run. This makes sense as arteries are designed to function in a high pressured system where as veins are not. As most of the arteries are essential to the survival of an organ, few options are available for using an arterial graft other than the internal mammary artery graft. These include the radial artery graft and an artery from the stomach. Use of these arteries is relatively recent and so the long term success rate is still not known. Several studies have shown that the short term success rate is similar to other grafts (vein or mammary artery grafts).
At present, radial artery graft is a good alternative for patients without good veins in the leg, very young patients (where all attempts are made to have a good long term success rate), some patients with diabetes and in patients undergoing repeat bypass surgery due to early failure of vein grafts. These indications are not yet proven in clinical trials as long term success rate of radial artery grafts is not known. Further, to use radial artery as a graft it has to be of a good size and there should be good circulation in the hand from the other artery supplying blood to the hand (ulnar artery).  
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