May 2022
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Use of second arterial grafts in coronary artery bypass grafting surgery (CABG)
Q1. What is an arterial graft?

Grafts are conduit pipes that are harvested from the patient’s body that are used to deliver blood to areas which are affected by heart. Veins are blood vessels that return blood to heart for oxygenation and arteries are blood vessels that deliver oxygenated blood to tissues.

Q2. Are arteries superior to veins in terms of longevity?

Yes and no. There are many caveats to using arterial grafts. The quality of coronary vessels and percentage of block in them also matters a great extent. But in carefully selected group of patients arterial grafts have been shown in several research studies to be superior in longevity rates to venous grafts.

Q3. Second arterial graft? What about first?

The configuration of grafts in CABG has traditionally and most commonly been to use Left Internal Mammary artery (LIMA- artery that supplies left side of breast bone) to graft the biggest vessel supplying the heart (Left anterior descending artery – LAD) and to use two venous grafts to bypass rest of the blocks in the heart.

Q4. What is Total arterial revascularization?

Bypassing all blocks in the heart using arterial grafts is called as Total arterial revascularization (TAR). But more is not necessarily merrier in this case. While research works have categorically proven superiority of a “second” arterial graft (other than LIMA), categorical evidence to show superiority of TAR over CABG done with one or two arterial grafts only (in case of a triple bypass) is lacking.

Q5. What are the arteries that can be commonly used as a conduit in CABG?

Radial arteries from both sides (forearm arteries), and Internal Mammary arteries (which supply the breast bone) are most commonly used arterial grafts

Q6. If artery is taken out of my forearm what will happen to my arm?

The clinician/ surgeon always checks to ascertain that there is adequate collateral circulation (blood supply from other sources) before deciding to use any arterial graft. Additional investigations might need to be carried out also to ascertain the same.

Q7. Are all patients who have been advised to undergo a CABG suitable candidates to receive a second arterial graft?

The surgeon has to carefully consider many aspects before deciding to use a second arterial graft. Most important of these considerations are the percentage of block in the coronaries and collateral supply to the area supplied by the artery (from where it will be harvested/ removed and used for bypass)

Dr Balamurali Srinivasan,
Senior Consultant for CardioVascular and Thoracic Surgery at KIMSHEALTH.

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