Using Arm Artery for Bypass No Better

(Ivanhoe Newswire) — Using the radial artery (within the forearm, wrist, and hand) doesn’t appear to be superior to the saphenous vein (from the leg) when performing coronary artery bypass grafting (CABG). Using the arm didn’t result in improved angiographic patency (the graft being open, unobstructed) one year after the procedure, according to a new study.

Coronary artery bypass grafting (CABG) is one of the most common operations performed, with a database indicating that in the United States, 163,048 patients had CABG surgery in 2008. The success of CABG depends on the long-term patency of the arterial and venous grafts. Arterial grafts are thought to be more effective than saphenous vein grafts for CABG based on experience with using the left internal mammary (breast) artery to bypass the left anterior descending coronary artery, according to background information in the article. The efficacy of the radial artery graft, which is easier to harvest than other arteries, is less clear. A database shows that more than 10,000 patients in the United States received radial artery grafts in 2008, suggesting that about 6 percent of patients undergoing CABG have radial artery grafts.

Steven Goldman, M.D., of the Southern Arizona VA Health Care System and the University of Arizona Sarver Heart Center in Tucson, and colleagues, compared one-year angiographic patency of radial artery grafts vs. saphenous vein grafts in 757 participants (99 percent men) undergoing elective, first-time CABG. The primary outcome measured was angiographic graft patency at one year after CABG. Secondary outcomes included angiographic graft patency at one week after CABG, heart attack, stroke, repeat revascularization and death.

The analysis included 733 patients (366 in the radial artery group and 367 in the saphenous vein group). The researchers found that there was no significant difference in one-year graft patency between radial artery (238/266; 89 percent) and saphenous vein grafts (239/269; 89 percent).

Also, there was no significant difference in one-week patency between patients who received radial artery grafts (285/288; 99 percent) vs. saphenous vein grafts (260/267; 97 percent) or in the other secondary outcomes. There was no difference in the number and types of adverse events, including serious adverse events.

“Although most clinicians assume that compared with vein grafts, arterial grafts have an improved patency rate, there are little multi-institutional prospective data on radial artery graft vs. saphenous vein graft patency,” the authors write.

SOURCE: JAMA, published online January 12, 2010