Multiple arterial grafts and survival

Limitations in the long-term patency of saphenous veins for bypass grafts h ave encouraged interest in the use of arterial conduits, The positive effec t of an internal thoracic artery graft on survival has been accepted for mo re than a decade, but it has proven difficult to show additional benefit fr om additional arterial conduits; this is probably due to multiple factors, including inappropriate choice of target vessels, short follow-up, and inad equate numbers of patients. Recently, however, the positive effect of a sec ond arterial graft was confirmed. It will probably be difficult to show a s urvival benefit from a third or fourth arterial graft, but we believe that complete arterial revascularization will result in improved long-term freed om from reintervention. Interest in arterial conduits for coronary artery bypass was primarily limi ted to the left internal thoracic artery until the mid-1980s, when enthusia sm for the use of bilateral internal thoracic arteries grew. More recently, the gastroepiploic artery, the inferior epigastric artery, and especially the radial artery have ail found advocates. However, the original conduit-a nd the standard against which all others are compared-is the greater saphen ous vein, (C) 1999 Lippincott Williams & Wilkins, Inc.