An Arm or a Leg for Your Coronary Bypass?

(I don’t mean the money – I assume you have Medicare-Plus.)  I’m thinking of the use of radial arteries (from the forearm) or saphenous veins (from the leg) for a coronary artery bypass graft (CABG).  Such procedures are done when the coronary arteries are seriously narrowed or blocked by atherosclerosis.  Most grafts use saphenous veins and/or internal mammary arteries (these are in the chest wall, running down behind the breastbone).   Arteries are thought to be superior to veins with regard to long-term patency, and the use of radial arteries has become more common in recent years.  Now a 5-year report from a study comparing the effectiveness and safety of radial arteries vs. saphenous veins, RAPS, is available; it was presented at the recent American College of Cardiology meeting. 

More than 560 patients were enrolled at 11 Canadian cardiac surgery centers. Their average age was 61, and all underwent a triple CABG. The 5-year status of radial artery and saphenous vein grafts were compared within the same patient, i.e. each patient received both types of graft randomized to two different sites – the right coronary and the right circumflex arteries.  The left internal mammary artery was used for the left coronary artery in all patients, and served as a control. 

The radial artery grafts were less likely than the saphenous vein grafts to become completely blocked after 5 years.  However, from a functional point of view, the difference between the two types of graft was less pronounced, although a smaller proportion of radial artery grafts than saphenous vein grafts were partially occluded.  The researchers note that, because of the study design, it wasn’t possible to determine if there was a difference in the clinical consequences of using one type or the other.

This means that, if you’re fated to have a CABG, you may end up with a scar on your forearm rather than on your leg.  Either way, you needn’t worry too much.  The 5-year survival rate in this study was 96%.