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Conduit Choice in CABG
Conduit Choice in CABG
Coronary Revascularization
Nora Albogami
PGY2
Table of contents:
• Introduction
• IMA
• Radial artery conduit
• SVG
• Other choices
• Coronary artery bypass graft is the gold standard for coronary surgical
revascularization.
• Life expectancy
• Age
• Comorbidities
• Elective vs emergency surgery
• Target vessel
The decision regarding the optimal strategy for coronary
revascularization has been one of continuous change over the last 50
years during which CABG has evolved.
• Technically demanding
• Provides competitive flow
Radial Artery:
Advantages vs disadvantages
Radial artery conduit:
Advantages:
• Ease of handling
• Ability to reach all coronary targets
• 10-year patency rates of 85% to 90%
• Recent studies advocating all-arterial
grafting, especially in patients with
diabetes. With or without aortic
anastomoses.
Radial artery conduit:
Disadvantages:
• More prone to spasm, due thicker smooth muscle media
• Prone to competitive flow
• CI in vasculitis or Raynaud’s syndrome, incomplete palmar arch
• 5% incidence of median nerve injury
• Risk of String sign
SVG:
1. Anatomy and Histology
2. Advantages vs disadvantages
Anatomy and histology:
• SVG has a larger diameter (3.1 to 8.5 mm)
• wall thickness ranges from 180 to 650
microns.
• its course
SVG:
Advantages:
• 85% patency rate after 1 year
• 70% after 10 years
• 25% after 20 years
• Available length of conduit
• Large competance vessle
• No risk of competitive flow
Disadvantages:
• 10% early occlusion and approximately
• 5% per year stenosis and/or occlusion
• Intimal thickening
Thus, limiting the long term benefits of coronary artery bypass graft
(CABG) surgery with SVGs
Enhancing techniques of SVG:
• Avoid tension/ traction, over distention (no touch technique)
• Size mismatch
• Quality check (varicosites, atherosclerotic changes, calcifications,
valves)
For patients in whom no other conduit is
available:
o Right gastroepiploic
o Inferior epigastric artery
o Ulnar artery
o Left gastric artery
o Splenic artery
o Thoracodorsal artery