Arterial grafts do not counteract target vessel occlusion.
OBJECTIVES
Grafted, non-occluded coronary arteries might contribute substantially to the myocardial blood supply and serve as a basis for vascular collateralization which preserves the myocardium in the event of graft occlusion. Early studies indicated that grafting with saphenous vein, but not internal mammary arteries, accelerates coronary atherosclerosis. This has not been extensively studied for the radial artery, which like the internal mammary artery (IMA) is largely resistant to atherosclerosis. A differential effect of various grafts might facilitate identification of disease-modifying principles. Our surgical cohort represented an opportunity to analyse new native coronary occlusions by comparison with preoperative angiograms.


METHODS
One hundred and two patients underwent angiography 1.3-3.9 years after coronary artery bypass surgery, primarily in order to compare the patency of radial artery, IMA and saphenous vein grafts.


RESULTS
Out of 290 stenotic, grafted vessels, 67 (23%) occluded during follow-up. Native occlusion occurred in 47% of the patients and correlated with serum-cholesterol. In a per target analysis, independent predictors of postoperative native occlusion were the right coronary artery territory, patent corresponding graft, the corresponding graft being an IMA and end-to-side anastomosis.


CONCLUSIONS
Target vessel occlusion is similar with radial artery and saphenous vein grafts and proceeds rapidly even in the current era of secondary prophylaxis against atherosclerosis. Competitive graft flow appears to promote occlusion. Contrary to previous studies, we do not find vein grafts to be inferior to IMA grafts with respect to preservation of native vessel patency.
['Bartnes|Kristian|K|', 'Hermansen|Stig E|SE|', 'Dahl-Eriksen|Øystein|Ø|', 'Bahar|Ramez|R|', 'Busund|Rolf|R|', 'Sørlie|Dag G|DG|', 'Myrmel|Truls|T|']
D000328:Adult D000368:Aged D016009:Chi-Square Distribution D017023:Coronary Angiography D001026:Coronary Artery Bypass D003331:Coronary Vessels D005260:Female D006083:Graft Occlusion, Vascular D006801:Humans D008297:Male D008323:Mammary Arteries D008875:Middle Aged D017534:Radial Artery D012501:Saphenous Vein D014654:Vascular Patency
Coronary arteries Bypass surgery Graft disease