The Ideal Conduit for Surgical Revascularization

Coronary artery bypass grafting has been an important treatment option for patients with significant obstructive and flow-limiting coronary artery disease for decades. Although there was a decline in the number of procedures performed with the introduction of and subsequent improvements in percutaneous revascularization, surgical revascularization continues to be an appropriate and effective therapy for many patients. The issue of what conduit to use for surgical revascularization has been studied and debated for decades as well. There are many choices for the surgeon and cardiologist to consider and choose from, including saphenous vein, internal thoracic artery, radial artery, gastroepiploic artery, and in some cases, umbilical vein or cryopreserved vein. For patients having surgical revascularization, there is a clear advantage in clinical outcomes when the left internal thoracic artery is used to bypass the left anterior descending coronary artery.1,2 For additional grafts, or the choice of the best conduit to other coronary arteries, the evidence is less clear. Historically, the greater saphenous vein has been the most commonly used conduit for additional grafts, but many clinical and bench studies have examined the use of additional arterial conduits to improve long-term patency and outcomes. The radial artery as a choice for the second conduit was initially described in 1973 by Carpentier et al3; however, it quickly lost favor, because early angiographic studies revealed poor patency. Over time, with improvements …