Radial artery versus saphenous vein conduits for coronary artery bypass surgery: forty years of competition — which conduit offers better patency? A systematic review and meta-analysis

Abstract

The internal thoracic artery is the most effective conduit for coronary artery bypass surgery; however, most patients have multivessel disease and require additional saphenous vein or radial artery grafts. In this systematic review of the literature and meta-analysis, we aim to compare reported patency rates for these conduits and explore if differences are homogeneous across follow-up intervals. A literature search was performed using Embase, Medline, Cochrane Library, Google Scholar and randomised controlled trial databases to identify studies published between 1965 and October 2009. All studies reporting angiographic comparison of saphenous vein and radial artery conduit patency were included, irrespective of language. The end point was angiographic graft patency stratified over different follow-up intervals. Meta-analysis was performed according to recommendations from the Cochrane Collaboration and Meta-analysis Of Observational Studies in Epidemiology guidelines. We used a random-effect model and the odds ratio as the summary statistic. A total of 35 studies were identified. They reported early patency (≤ 1 year, 6795 grafts), medium-term patency (1-5 years, 3232 grafts) and long-term patency (>5 years, 1157 grafts). Significant variation of comparative patency existed across different follow-up intervals. Early saphenous vein patency was similar to radial artery patency with odds ratio of 1.04 (95% confidence interval 0.68-1.61). Medium-term saphenous vein patency, however, deteriorated significantly (odds ratio 2.06, 95% confidence interval 1.29-3.29). Similarly, long-term patency was better for radial artery conduits (odds ratio 2.28, 95% confidence interval 1.32-3.94). Heterogeneity was due to angiographic patency characteristics and related to risk of bias. In conclusion, the findings of this systematic review of the published literature and meta-analysis support the use of radial artery in preference to saphenous vein conduits for coronary artery bypass surgery.

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

“…В двух рандомизиро-ванных исследованиях проходимость шунта из луче-вой артерии через 1 год была неодинаковой -как "превосходной", так и "эквивалентной" венозным шунтам [414,415]. В дополнительном небольшом рандомизированном исследовании 5-летняя прохо-димость шунта из лучевой артерии была достоверно лучше, чем венозных шунтов, если их соединяли с системой огибающей артерии [416,417].…”

Radial Artery Free and T Graft Patency as Coronary Artery Bypass Conduit Over a 15-Year Period

“…18 Early radial artery patency was similar to vein graft patency, medium-term follow-up demonstrated deterioration in vein graft patency, and radial artery patency was superior in long-term followup. The long-term radial artery patency ranged from 85% to 94.9% and the saphenous vein patency ranged from 64.5% to 91.7%; the pooled OR for 7 studies indicated better patency with the radial artery conduits.…”

“…The long-term radial artery patency ranged from 85% to 94.9% and the saphenous vein patency ranged from 64.5% to 91.7%; the pooled OR for 7 studies indicated better patency with the radial artery conduits. 18 The authors suggested a nonhomogeneous comparative patency of radial arteries and saphenous vein grafts over time and recommended preferential radial artery use over saphenous vein use for CABG conduit in all patients who have a life expectancy Ͼ5 years. This meta-analysis lends support for the durability of radial artery grafts after the initial postoperative period.…”

Radial Artery and Saphenous Vein Grafts in Coronary Artery Bypass Surgery Comparison in Terms of Patient Symptoms

“…[2] [4] The use of SV was pioneered by Favaloro in early years of CABG [3] [4]. Studies shows that patients with hypertension, diabetes, peripheral vascular disease, aortic disease and stroke have higher risk for coronary artery disease especially in elderly patients [5].…”