Feature | April 08, 2011

Radial Artery Outperforms Saphenous Vein Graft in CABG Patients

April 8, 2011 – A Canadian research team found that the radial artery outperformed the saphenous vein as the best conduit for coronary artery bypass graft (CABG) surgery. The radial artery also led to reduced rates of functional or complete graft occlusion, according to research presented this week at the American College of Cardiology’s 60th Annual Scientific Session.

The study was conducted at 13 centers across Canada and enrolled 561 patients who underwent CABG surgery for three-vessel disease. Each patient received both a radial artery (the major artery in the thumb side of the arm) graft and a saphenous vein (the main leg vein) graft at two different diseased vessel sites. The primary endpoint of functional graft occlusion was determined through invasive angiography at least five years after surgery. The secondary endpoint was complete graft occlusion determined through invasive angiography or computed tomography angiography.

The research team conducted late angiography on 440 patients alive at one year and on 269 patients at a mean of 7.6 (+1.5) years post-procedure. In the latter follow up, the researchers found that significantly fewer radial arteries became partially occluded than saphenous vein grafts, at 12.0 percent and 18.8 percent, respectively (p = 0.05, odds ratio [OR] 0.64, 95 percent confidence interval [CI] 0.41 – 0.98). Significantly fewer radial arteries also became completely occluded, at 8.9 percent, than saphenous veins, at 17.8 percent (p = 0.004, OR 0.50, 95 percent CI 0.32– 0.80).

In the researchers’ previously published one-year results, complete graft occlusion was significantly reduced in the radial artery compared to the saphenous vein, while partial graft occlusion was similar between the two conduits.

“Our study shows that the radial artery does seem to offer an improvement in graft patency compared to vein grafts,” said Stephen Fremes, M.D., MSc, lead study author and head of the division of cardiac and vascular surgery, Schulich Heart Centre, at Sunnybrook Health Sciences Centre in Toronto.

Cardiac specialists have long debated which conduit provides better long-term graft outcomes. Many believe that the radial artery is superior to the saphenous vein because arterial grafts develop fewer diseases and better withstand aortic pressure. However, most of the studies proving this have been done using the left internal thoracic artery, not the radial artery.

“The left internal thoracic artery was shown in the 1980s to be superior to a vein graft, and as a result, there was a wave of enthusiasm to use this artery – as well as other arteries – for either more complete arterial revascularization or total arterial revascularization,” Fremes said. “The radial artery possesses some advantages relative to the internal thoracic artery; it has thicker walls, which makes suturing easier, and a greater length that can reach all targets on the heart.”

In addition to finding lower rates of occlusion in the radial artery grafts, the research team also found that radial artery grafts worked better when grafted to more thoroughly diseased vessels. Specifically, the researchers separated the target vessels into three groups: those with 70-89 percent narrowing, 90-99 percent narrowing, and 100 percent narrowing. They found a much lower failure rate (approximately 50 percent) for radial artery grafts that were grafted to vessels with 90 percent narrowing or more.

“The implications from our one-year study were confirmed in the five-year results – radial artery bypass grafts should be used preferentially for the most severely narrowed coronary arteries,” Fremes said.

Fremes noted that because each study patient received both graft types, the researchers were unable to associate clinical outcomes with a specific grafting strategy. He added that late findings from an Australian study and a study conducted by the Veterans Affairs Cooperative Studies program will provide both angiographic and clinical outcomes.

The study was funded by the Canadian Institutes of Health Research. Fremes had no financial disclosures related to the study.

For more information: www.cardiosource.org

Related Content

PCI outcomes, public reporting, high-risk patients, JAMA Cardiology, Beth Israel Deaconess Medical Center study
News | Cath Lab| July 27, 2016
July 27, 2016 — A number of states mandate public reporting of mortality outcomes following certain cardiac procedure
News | Genetic Testing| July 26, 2016
July 26, 2016 — A new study has identified a genetic error that weakens the aorta, placing patients with this and sim
CMS, bundled payment models, coronary artery bypass surgery, ACC, STS
News | Business| July 26, 2016
July 26, 2016 — The Centers for Medicare & Medicaid Services (CMS) has proposed the creation of new...
heart failure, after first heart attack, cancer risk, JACC study
News | Cardiac Diagnostics| July 21, 2016
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared...
mitral valve surgery outcomes, twisting of the heart, echocardiography, NICSMR, JACC Basic to Translational Science
News | Heart Valve Technology| July 20, 2016
A novel study has found a simple pre-operative echocardiographic measurement of the amount of torsion of the heart...
TITAN II Trial, Carillon Mitral Contour System, Cardiac Dimensions, Open Heart journal, functional mitral regurgitation, FMR
News | Annuloplasty Rings| July 20, 2016
New data from the TITAN II trial confirm the safety and efficacy of the Carillon Mitral Contour System in the treatment...
Mitralign, Trialign system, tricuspid regurgitation. SCOUT U.S. study, phase 1 enrollment
News | Heart Valve Technology| July 19, 2016
Mitralign Inc. announced last week it has completed subject enrollment in the SCOUT early feasibility study in the...
sudden cardiac arrest, out-of-hospital, comatose patients, University of Arizona study, wake up
News | Sudden Cardiac Arrest| July 13, 2016
Physicians may be drawing conclusions too soon about survival outcomes of patients who suffered a cardiac arrest...
radial access, inserting stents, JACC Cardiovascular Interventions study
News | Radial Access| July 13, 2016
A new study in JACC: Cardiovascular Interventions supports access through the wrist, or radial access, as the default...
University of Guelph study, heart failure risk, gender, aging
News | Heart Failure| July 08, 2016
University of Guelph researchers have uncovered a possible clue as to why women have lower rates of heart failure than...
Overlay Init