vein graft vs artery graft

Vein graft failure. This issue of Interventional Cardiology Clinics covers bypass graft lesions and thrombectomy. An independent data monitoring committee reviewed the unblinded study data every 6 months. Subgroup analysis for the primary composite outcome of death, myocardial infarction, or repeat revascularization. The use of the left internal mammary artery (IMA) has been shown to improve long-term survival and has been a gold standard in coronary artery bypass grafting (CABG). Objectives: Avoiding valves during vein harvest would help reduce graft failure. 1995 Jan;25(1):188-92 This new edition; Contains a radically expanded chapter contents list presented in four clear sections; coronary interventions, interventional pharmacology, structural heart interventions, and endovascular therapy Includes 46 new chapters, ... Although use of a left internal mammary-artery graft is standard for patients undergoing coronary-artery bypass grafting (CABG), most other bypass grafts use saphenous-vein conduits — at least in part because few high-quality data demonstrate clinical benefits of radial-artery grafts. Because the important question is long-term patency, the VA Cooperative Studies Program has funded a 5-year angiographic follow-up of these patients to define chronic graft patency in this population. Prevention and treatment information (HHS). Study supervision: Goldman, Sethi, Holman, McFalls, Ward, Rhenman, Bakaeen, Kasirajan, Ratliff, Irimpen, Thomas, Fremes, Moritz, Wagner, Rodriguez, Juneman, Pierce, Kreamer, Lee. However, it is still not clear what the best conduit is for non-left anterior descending coronary arteries. dial artery grafts vs saphenous vein grafts. Conflict of Interest Disclosures: Dr Fremes reported receiving grants from the University of Toronto during the conduct of the study and grants from the Canadian Institutes of Health Research outside the submitted work. We analyzed costs and logged costs using linear regression with robust standard errors. Grafting the left anterior descending artery with the left internal thoracic artery is the gold standard in CABG because patency rates of this construction surpass … A, Cumulative incidence of the composite outcome of death, myocardial infarction, or repeat revascularization. Median (interquartile range) observation time: 10.0 (8.5-11.4) years in the radial artery group vs 10.0 (6.1-10.2) years in the saphenous vein group. Dr Biondi-Zoccai reported consulting for Abbott Vascular and Bayer. Percutaneous Intervention Post Coronary Artery Graft Surgery in Patients with Saphenous Vein Graft Disease - State of the Art. The improved patency of the in situ left internal mammary has led investigators to explore the use of other arterial grafts, such as the right internal or free internal mammary, the gastroepiploic, the splenic, and the radial artery, with the radial artery being the easiest to harvest. This is the most authoritative textbook ever dedicated to the art and science of surgical coronary revascularization, with 71 chapters, organized in 9 sections, and written by over 100 recognized world experts. Minnesota: Edward McFalls, MD; Rosemary Kelly, MD; Herb Ward, MD (past); Deborah Johnson, RN. The surgery was performed on pump for 644 of 733 patients (88%: radial artery, 325/366; 89%; 95% CI; 86%-92%; saphenous vein, 319/367; 87%; 95% CI, 83%-90%). The patency rates of saphenous vein grafts were 71-87% at 1 year after surgery in previous studies [16-18] and up to 50% at 10 years [16-21]. Bookshelf Other studies of complete arterial revascularization appear to favor arterial grafts in diabetic patients despite this propensity for atherosclerosis,14 while in a recent trial, the use of a radial as a second arterial conduit as opposed to vein grafting did not confer a survival benefit in diabetic patients.15 This unexpected result is perhaps related to the augmented radial vasoreactivity and atherosclerotic disease characteristic of patients with diabetes. In short-term grafts (less than 1 year), many of the cells inside the human veins displayed both endothelial and mesenchymal cell characteristics, while in long-term grafts (more than 6 years) the . Found insideRather than providing detailed and exhaustive reviews – a criticism of many Interventional Cardiology texts – the purpose of this book is to present practical information regarding Interventional procedures and important topics in ... ABSTRACT: Coronary artery bypass graft (CABG) is performed to improve blood supply to the myocardium. Analysis and interpretation of data: Goldman, Sethi, Holman, Kelly, Bakaeen, Crittenden, Ratliff, Fremes, Moritz, Reda, Harrison, Wagner, Wang, Rodriguez, Juneman, Morrison, Pierce, Kreamer, Shih, Lee. We also performed as-treated and per-protocol analyses and multiple imputations as sensitivity analyses to the intent-to-treat analysis on primary end point. In the saphenous vein group, the 1-year patency was lower in patients who underwent endoscopic vessel harvesting than in those who underwent other vessel harvesting (endoscopic, 40/51; 78%; 95% CI, 67%-90%; other, 199/218; 91%; 95% CI, 88%-95%; P = .009). Design, Setting, and Participants Multicenter, randomized controlled trial conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers among 757 participants (99% men) undergoing first-time elective CABG. The use of radial artery grafts for CABG was linked to lower risk for CV outcomes and improved survival compared with the use of saphenous vein grafts, according to 10-year follow-up data from the . One-year graft patency data were missing if patients whose study grafts were patent at 1 week did not undergo an angiogram within the time window or if the central angiography laboratory was not able to determine graft patency. This comprehensive text covers all the important aspects of the heart and vascular system. The most important and relevant disorders are presented, with emphasis on the mechanisms involved. Accessibility In this individual participant data meta-analysis from 5 randomized clinical trials that included 1036 patients undergoing coronary artery bypass grafting … Context Arterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with … Study grafts that were occluded at 1 week after CABG were considered occluded at 1 year. The great saphenous vein, which is the large vein running up the length of the leg, often is used as the bypass conduit due to its size and the ease of removing a small segment. Texas: Faisal Bakaeen, MD; Joseph Huh, MD (past); Ernesto Soltero, MD (past); Gabriel Habib, MD; Pamela Smithwick, RN. Customize your JAMA Network experience by selecting one or more topics from the list below. These findings indicate that the radial artery conduit advantage demonstrated by others in the general CABG population may primarily be in patients who do not have diabetes. Objective:  et al; Radial Artery Patency Study Investigators.  Impact of patient and target-vessel characteristics on arterial and venous bypass graft patency.Â, Miwa S, Desai N, Koyama T, Chan E, Cohen EA, Fremes SE.Radial Artery Patency Study Investigators.  Radial artery angiographic string sign.Â, Singh SK, Desai ND, Petroff SD, Dr Puskas reported receiving royalties from surgical instruments invented by the author from Scanlan Inc and personal fees from Medtronic outside the submitted work and having a patent to surgical instruments issued and licensed, with royalties paid. There were no significant differences in Health Utilities Index scores at 3 months (mean [SD] scores, saphenous vein, 0.67 [0.29]; radial artery, 0.64 [0.27]; P = .40) or 12 months (saphenous vein, mean [SD], 0.67 [0.29]; radial artery, 0.64 [0.27]; P = .23). This review offers a comparison between the saphenous vein … The radial artery was associated with a significantly lower incidence of graft failure (p < 0.05) and of repeat coronary operation (p < 0.05). 8600 Rockville Pike However, 1-year catheterization completion rate (73%) was higher than expected, and the post hoc power to detect 92% vs 83% patency was 89%. Results: Found insideThe book includes comprehensive descriptions and review of pathology, clinical presentations, diagnosis, pharmacotherapy, interventions and future trends. Results: Six trials (1,860 participants, 1,188 radial artery grafts, 1,178 saphenous vein grafts) were included in this review. CI indicates confidence interval; LAD, left anterior descending artery. Study concept and design: Goldman, Sethi, Holman, McFalls, Ward, Rhenman, Soltero, Crittenden, Fremes, Moritz, Reda, Harrison, Wagner, Morrison, Lee. The difference was not significant in the radial artery group (on pump, 221/247; 89%; 95% CI, 86%-93%; off pump, 17/19; 89%; 95% CI, 76%-100%; P = .99). Because it has been associated with a lower incidence of wound complications and infections, it has become the most common technique used for harvesting vein. If one reader noted the maximum of the percent stenosis at the 3 sites, then another reader could examine the development of disease in the study grafts at 1 year (Table 3). Graft choice is a critical element for long-term patency and survival in coronary artery bypass grafting surgery (CABG) [].The left internal mammary artery (LIMA) has a greater long-term patency compared to the saphenous vein and significantly improves the long-term patient outcome when it is anastomosed to the left anterior descending artery (LAD) []. Methods: A PubMed search was made of the literature utilizing both the Weill Cornell Medical Library and Johns Hopkins Medical Library resources. Only full text, English language articles were used in this review. The 5 deaths within 30 days of surgery included 1 cardiac death, 1 sudden death, 1 due to infection, 1 due to postoperation complications, and 1 for an unknown reason. The chapters in this book cover different aspects of manufacturing scaffolds with various polymers, mechanical characteristics, degradation rates, decellularization techniques, cell sheet assembly, 3-D printing and autologous mandril-based ... As determined by the GRADE method, the evidence quality was low for repeat operation and very low for other variables. (Refer to eAppendix for reasons.) But unlike a fistula, an AV graft is a synthetic tube used to surgically connect the artery and vein. There was no difference in 1-week patency between patients who received radial artery grafts (285/288; 99%; 95% CI, 97%-100%) vs saphenous vein grafts (260/267; 97%; 95% CI, 95%-99%), nor between patients who underwent endoscopic vessel harvesting (61/63; 97%; 95% CI, 96%-100%) vs other vessel harvesting (484/492; 98%; 95% CI, 97%-99%). A graft is used to replace or bypass the blocked part of the artery. Biomechanical forces may play a key role in saphenous vein graft (SVG) disease after coronary artery bypass graft (CABG) surgery. 6. Results: West Roxbury: Miguel Haime, MD; Michael Crittenden, MD (past); Scott Kinlay, MD; Lorrie Kelley, RN. With catheterizations at 1 week and 1 year after surgery, we can also separate the perioperative technical surgical problems from the pathophysiology of disease progression over 1 year and have a known denominator to define 1-year patency. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. Kaisar J, Chen A, Cheung M, Kfoury E, Bechara C, Lin P. Comparison of propaten heparin-bonded vascular graft with distal anastomotic patch versus autogenous saphenous vein graft in tibial artery bypass. A 2-sided P < .05 indicated statistical significance. Analyses were performed using SAS version 8.2 (SAS Institute, Cary, North Carolina). The SV graft failure is predominantly seen at the valve site. Coronary Revascularization Strategies: Making Sense of Sparse, Limited-Quality Data. Bookshelf Use of calcium-channel blockers was higher in the radial artery group (saphenous vein, 70/367; 19%; radial artery, 162/366; 44%; P < .001) (eTable 2). Dr Hare reported receiving personal fees from the National Health and Medical Research Council of Australia and grants from the National Heart Foundation of Australia during the conduct of the study and personal fees from Amgen, AstraZeneca, Merck, and Pfizer and nonfinancial support from Lundbeck, Servier, and Vifor outside the submitted work. There was no significant difference in 1-year graft patency between radial artery (238/266; 89%; 95% CI, 86%-93%) and saphenous vein grafts (239/269; 89%; 95% CI, 85%-93%; unadjusted odds ratio [OR], 1.07; 95% CI, 0.62-1.84; P = .82) (Table 3). Mohr, F. W. et al. This book is a comprehensive and richly-illustrated guide to cardiac CT, its current state, applications, and future directions. Results Analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). May improve patient outcomes occlusion may improve patient outcomes Kasirajan, MD ; William Gunnar, MD ( past ;! 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