Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 218

Radial grafts have similar 1-year patency to SVGs, but very low attrition rate beyond the first year and better long-term patency (85% at 5 years).^110,111 Radial grafts are very prone to spasm and more prone than any other graft to early failure if the underlying native stenosis is not severe or the target artery is not large. They are probably best used when stenosis is >90% and the recipient artery is very large.¹¹¹ Moreover, radial grafts are more susceptible to atherosclerosis than mammary arteries.

RIMA may also be used, as in-situ or free graft, mainly for RCA or LCx. It may be used as a free rather than in-situ graft to the distal RCA and sometimes LCx branches, because RIMA may be too short to reach these branches. RIMA has a better patency than radial and SVG grafts but may be technically more challenging with a risk of sternal wound infection, especially in patients with diabetes.¹¹²

The gastroepiploic artery may be used as a free or in-situ graft.

A classical CABG surgery involves grafting a LIMA to the LAD, one or several SVGs to diagonal(s), obtuse marginal branch(es), and distal RCA (or its PDA or PLB branch). Instead of SVGs, radial or free RIMA grafts may be used.

In distal left main disease, both the LAD and one of the obtuse marginal branches are bypassed.