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

ICDs, implantable cardioverter defibrillators, survival rate, elderly patients, JACC study
News | Implantable Cardioverter Defibrillators (ICD)| January 17, 2017
Of patients over age 65 who received an implantable cardioverter-defibrillator (ICD) after surviving sudden cardiac...
University of Utah, Frank Sachse, heart failure, LVAD implantation, left ventricular assist device, biomarker, t-system

Two patients may seem equally sick based upon clinical measures, but differences in their heart physiology could predict who has the potential to recover from heart failure. A study carried out by scientists at the University of Utah finds that patients whose hearts have flattened t-tubules have a decreased chance of showing signs of recovery after implanting a mechanical heart pump. Ordinarily, t-tubules in the heart are long, thin, and rounded. Image courtesy of Frank Sachse.

News | Cardiac Diagnostics| January 17, 2017
Investigators at the University of Utah have identified distinct differences in the hearts of advanced heart failure...
Synergy stent, abluminal polymer DES, bioresorbable polymer DES, bioresorbable polymer metallic stent

The Synergy stent is the first FDA cleared drug-eluting stent to use a bioresorbable polymer drug carrier. When the polymer dissolves after about four months, the devices become a bare metal stent. The technology is supposed to reduce the rate of late stent thrombosis due to vessel inflammation caused by durable polymers.

Feature | Stents Bioresorbable| January 17, 2017 | Dave Fornell
One of the big advancements in drug-eluting stent (DES) technology has been the development of bioresorbable polymers
St. Jude Medical, Amplatzer Amulet LAA Occluder, observational study, TCT 2016
News | Left Atrial Appendage (LAA) Occluders| November 03, 2016
St. Jude Medical Inc. presented favorable results from the largest observational study to date of the company’s...
Medtronic, CoreValve Evolut R TAVR system, U.S. IDE Study, TCT 2016
News | Heart Valve Technology| November 03, 2016
Medtronic plc unveiled new clinical data showing that patients treated with the self-expanding CoreValve Evolut R...
open-heart surgery, PCI, percutaneous coronary intervention, NOBLE trial, left main coronary artery disease, LMCAD, TCT 2016
News | Cardiovascular Surgery| November 03, 2016
Coronary artery bypass (CABG) surgery is the standard treatment for revascularization in patients with left main...
News | Drug-Eluting Balloons| November 03, 2016
The Spectranetics Corp. announced that it has submitted to the U.S. Food & Drug Administration (FDA) its Pre-Market...
Medtronic, Resolute Integrity DES, drug-eluting stent, BIO-RESORT study, TCT 2016
News | Stents Drug Eluting| November 02, 2016
Investigators recently unveiled clinical data from the independent BIO-RESORT study, representing the first all-comers...
Medtronic, Harmony TPV, transcatheter pulmonary valve, clinical study results, TCT 2016
News | Heart Valve Technology| November 02, 2016
Medtronic plc recently announced new clinical data for the Harmony Transcatheter Pulmonary Valve (TPV) from its early...
Medtronic, Drug-Filled Stent, DFS, RevElution trial, first clinical data, TCT 2016, Stephen Worthley
News | Stents Drug Eluting| November 01, 2016
November 1, 2016 — Medtronic plc unveiled the first clinical outcomes of its novel...
Overlay Init