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J Thorac Cardiovasc Surg 2001;121:431-433
© 2001 The American Association for Thoracic Surgery

Editorials

Arterial grafts for coronary surgery: Vasospasm and patency rate

From the Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.

Received for publication Nov 29, 2000. Accepted for publication Dec 1, 2000. Address for reprints: Professor Guo-Wei He, Department of Surgery, The Chinese University of Hong Kong, Block B, 5A, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China (E-mail: gwhe@cuhk.edu.hk).

For related article, see p. 520.

Interest in the use of arterial grafts in coronary artery bypass grafting (CABG) has increased significantly for the following reasons: (1) The number of patients receiving arterial grafts has risen sharply in most major cardiac surgery centers around the world; (2) the number of arterial grafts received per patient has increased; (3) more diverse arteries are used as grafts than previously; (4) more is understood about the biologic characteristics of arterial grafts; (5) clinical protocols for the use of arterial grafts are more advanced; and (6) midterm results with alternative arterial grafts are encouraging in a large number of patients.

It is widely accepted that the left internal thoracic artery (ITA) is the artery of choice for an arterial graft. Opinions differ, however, as to the second choice for an arterial graft, which frequently depends on the personal preference of the surgeon. The right ITA, the radial artery (RA), and the right gastroepiploic artery (GEA) are the candidates for second choice for arterial grafts for CABG. In general, which artery is chosen depends on the surgeon's views about the quality of the graft, that is, its length and diameter, whether the artery can be used as a pedicle graft, the technical difficulties, the incidence of vasospasm, and the possible superior long-term patency. Usually, pedicle grafts are considered to be superior to free grafts because the anatomic structure of the pedicle artery is thought to be more intact (the nerve and the blood supply to the vaso vasorum are better preserved in the pedicle graft). On the other hand, for arterial grafts such as the GEA, the pattern of direct flow from the ascending aorta in the free graft is better than that from the abdominal aorta (in the in situ pedicle graft). Therefore, . . . [Full Text of this Article]

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