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Graft patency in saphenous vein, radial artery no different at one year
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American College of Cardiology 59th Annual Scientific Session
ATLANTA – Results of a VA Cooperative study suggested that both saphenous vein grafts and radial artery grafts resulted in graft opening at one year.
Researchers randomly assigned 733 patients undergoing CABG to receive either radial artery grafts (n=366) or saphenous vein grafts (n=367). The researchers hypothesized that the radial artery would have better patency at one year, proposing that one-year patency rates would be 92% for the radial artery grafts and 83% for the saphenous vein grafts.
According to the study results, one-week patency for the radial artery grafts was 99% vs. 97% for the saphenous vein grafts. At one year, patency was the same for both groups (89% vs. 89%). For the secondary endpoints, there was more high-grade disease in the radial artery group vs. the saphenous vein group (8% vs. 1%, P<.001). There was also a slight reduction in the procedural costs in the saphenous vein group vs. the radial artery group ($12,484 vs. $13,629, P<.01).
“There was no difference in the radial artery vs. saphenous vein graft patency after one year, and we realized that cardiac surgery is an operation designed to improve things in the long-term,” Steven Goldman, MD, chief of cardiology at the Tucson Veterans Affairs Medical Center, Southern Arizona VA Health Care System, said here in a presentation. “We need to be able to look at long-term patency, and the VA has funded us for a five-year angiography follow-up of this study, so we will be able to tell you what happened to these patients in five years. Importantly, we have the denominator, so we can tell you what is going on with the patients now.” – by Eric Raible
When we think about vein and arterial grafts, they really have different modes of failure — particularly when you have a muscular arterial graft like in the radial artery. Coronary locations, and what we call competitive flow or residual late blood flow, have been shown to be extremely important. One of the things with this study that differs from what is in most of the literature is that they did not find a dependency on radial artery patency as to which coronary was grafted. The literature essentially states that when you graft a left-sided vessel, the patency is better than in a right-sided vessel. The other thing that is extremely important, and probably the biggest determinant of arterial graft patency, is competitive flow or residual flow in the native blood vessel. Because arterial grafts are muscular, they have the ability to respond to the myocardial blood flow needs; so, if you graft an artery that has moderate stenosis, there is a likelihood that the arterial graft may fail. It will constrict, atrophy and essentially close with time.
– Joseph F. Sapik, MD
Chairman, Thoracic and Cardiovascular Surgery
Cleveland Clinic, Cleveland, OH
For more information:
- Goldman S. LBCT V. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
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