Arterial Conduits for Surgical Revascularization

Coronary artery bypass grafting (CABG) remains a commonly performed procedure for obstructive coronary artery disease that is not treatable with either medical therapy or percutaneous intervention. It has been well studied and documented that using the left internal thoracic artery (LITA) reduces morbidity and mortality compared with using saphenous vein grafts (SVGs) when performing a CABG.1 One reason for the observed improved outcomes is the anatomic structure and the preserved and functional endothelium of the internal thoracic artery compared with an SVG. It was assumed that this inherent superiority of the LITA would also be true for the right internal thoracic artery (RITA) and other arterial conduits that could be safely procured and used for bypassing coronary arteries. However, this assumed inherent superiority of using any arterial conduit compared with using an SVG to targets other than the left anterior descending artery has been much harder to prove. Two recent reports of using a meta-analysis of radial artery versus SVG reached different conclusions.