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Recent Strategies to Improve Graft Performance in Patients Undergoing Coronary Artery Bypass Surgery. Are Best Results Achieved by Improved Surgical Techniques of Graft Preparation?

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Advances in Vascular Medicine

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Abstract

The patency rate of the saphenous vein (SV) used as a graft in patients undergoing coronary artery bypass surgery (CABG) is poor, with 15-25% grafts occluding within 1 year and over 50% patients requiring further (redo) surgery within 10 years.1 In order to investigate the strategies to reduce vein graft failure in patients undergoing CABG, the underlying pathology of the disease must first be established. The high prevalence of coronary heart disease in Western society has prompted surgeons to develop procedures to improve myocardial blood flow, and subsequently relieve the symptoms of angina pectoris along with other myocardial crises.2 One of the most significant advances in vascular surgery was the finding that venous conduits could be used as replacements for atherosclerotic arteries. Following the work of Alexis Carrel at the turn of the century, a venous graft was first used in 1906 to replace a popliteal aneurysm.2 Promising experimental results encouraged surgeons to apply this method to the coronary vessels. By the 1950s, at the Cleveland Clinic, Favaloro et al. had treated numerous cases of peripheral and renal artery reconstruction with venous conduits and employed this procedure in coronary vessels.3 Research efforts by Favaloro4 led to the development of CABG, a technique which has been used for almost four decades. The great SV of the leg is the conduit of choice for three main reasons. First, it is expendable as deeper vessels maintain blood flow to superficial tissues after its removal. Second, the extensive length of this vein allows for multiple grafts, and finally, its superficial position renders it easily accessible. A 10-year follow-up recatheterization of Favarolo’s first operation showed that both the graft and the bypassed right coronary artery remained patent.3 Such promising results reshaped the history of cardiac surgery and led to the rise of surgical revascularization in the treatment of ischemic heart disease.

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Authors and Affiliations

  1. Clinical Biochemistry, Royal Free and University College Medical School, London, NW3 2QG, UK

    Michael R. Dashwood

  2. Faculty of Biomedical and Life Sciences, West Medical Building, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK

    Rosa Baron

  3. Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, SE-701 85, Örebro, Sweden

    Mikael Arbeus & Derek Filbey

  4. Transfuión Medicine, Örebro University Hospital, SE-701 85, Örebro, Sweden

    Domingos S. R. Souza

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  1. Rosa Baron
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  2. Michael R. Dashwood
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  3. Mikael Arbeus
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  4. Derek Filbey
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  5. Domingos S. R. Souza
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Correspondence to Michael R. Dashwood .

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Editors and Affiliations

  1. University College London, Gower Street, London, WC1E 6BT, United Kingdom

    David Abraham

  2. The Royal Free & Univ College Med School, Gower Street, London, WC1E 6BT, United Kingdom

    Handler Clive

  3. University College London, Gower Street, London, WC1E 6BT, United Kingdom

    Michael Dashwood

  4. The Royal Free & Univ College Med School, Gower Street, London, WC1E 6BT, United Kingdom

    Gerry Coghlan

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Baron, R., Dashwood, M.R., Arbeus, M., Filbey, D., Souza, D.S.R. (2009). Recent Strategies to Improve Graft Performance in Patients Undergoing Coronary Artery Bypass Surgery. Are Best Results Achieved by Improved Surgical Techniques of Graft Preparation?. In: Abraham, D., Clive, H., Dashwood, M., Coghlan, G. (eds) Advances in Vascular Medicine. Springer, London. https://doi.org/10.1007/978-1-84882-637-3_21

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