Radial artery graft vs. saphenous vein graft for coronary artery bypass surgery. Which conduit offers better efficacy?

摘要

Objectives. Coronary artery bypass grafting (CABG) is the best therapeutic option for multivessel coronary artery diseases. The internal thoracic artery is usually used for the left anterior descending coronary artery. However, it is still not clear what the best conduit is for non-left anterior descending coronary arteries. This research sought to assess the efficacy of the radial artery versus the saphenous vein in this context. Methods. A systematic literature search was performed for randomized clinical trials (RCT) published in MEDLINE, EMBASE, and the Cochrane Library. RCTs reporting angiographic comparisons and clinical events of the radial artery versus the saphenous vein were included. Results. Six trials (1,860 participants, 1,188 radial artery grafts, 1,178 saphenous vein grafts) were included in this review. The radial artery was associated with a significantly lower incidence of graft failure (p<0.05) and of repeat coronary operation (p<0.05). There was no significant trend toward decreased cardiac death and myocardial infarction with the use of a radial artery (p>0.05; p>0.05). As determined by the GRADE method, the evidence quality was low for repeat operation and very low for other variables. Conclusion. The radial artery can be weakly recommended as a selective conduit but cannot always be considered better than the saphenous vein.