Total Arterial Revascularization in Coronary Artery Bypass Grafting Surgery

Coronary artery bypass graft (CABG) operations are one of the most commonly performed sur‐ gical procedures, with a worldwide prevalence of over 800,000 annually and more than 350,000 operations being performed in the United States each year [1]. The use of the left internal mam‐ mary artery (LIMA) is widely considered to be the gold standard for conventional CABG opera‐ tions. Its use has been shown to result in a lower incidence of reintervention, fewer myocardial infarctions, a lower incidence of angina, and lower associated mortality rates than with the use of saphenous vein grafts alone. Also when compared to saphenous vein grafts, LIMA use has been shown to have greater long-term patency results [1, 2]. For patients with multivessel coro‐ nary disease undergoing what is usually referred to as conventional CABG, the LIMA is typical‐ ly grafted to the left anterior descending (LAD) artery with saphenous vein grafts often used to bypass the remaining coronary occlusions. However, arterial conduits are now being more fre‐ quently used as choices for the second and third conduits in place of saphenous vein grafts to achieve total arterial revascularization (TAR) of the myocardium due to superior patency and long-term survival results. This article provides a review of TAR using the right internal mam‐ mary artery (RIMA) and radial artery as additional arterial conduits in conjunction with the LI‐ MA as a first choice conduit. The reported benefits of TAR when compared to conventional CABG procedures using the LIMA and saphenous vein grafts are discussed.