ACC Feature: Saphenous vein grafts appear equal to radial artery grafts

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ATLANTA--Saphenous vein grafts and radial artery grafts both result in equal graft opening at one year, according to a study presented as a late-breaking clinical trial Tuesday at the American College of Cardiology’s (ACC) 59th annual scientific session.

In 2008, Society of Thoracic Surgeons database showed that out of 163,048 CABG procedures, more than 10,000 of them were radial artery grafts, reported principal investigator Steven Goldman, MD, chief of cardiology at the Southern Arizona VA Health Care System in Tucson, Ariz. “That tells us that surgeons today are using radial artery grafts, but the answer to whether or not they are better than vein grafts is still unclear.”

He said the potential benefit is that arterial grafts are better conduits than veins.

Conducted at 11 Veterans Affairs medical centers between 2003 and 2008, the prospective study randomized patients undergoing elective CABG to receive either the radial artery or the saphenous vein. In the final analysis, 733 patients were included (366 with the radial artery, 367 with the saphenous vein).

For the study, the researchers hypothesized that radial artery would have better patency, specifically proposed one-year rates of 92 percent for the radial artery and 83 percent for the saphenous vein.

The study found that at one year, graft angiography revealed no difference in graft opening between the two conduits, with the radial artery leading to 89 percent, and the saphenous vein leading to 89 percent. Goldman reported that no significant differences were observed for the secondary endpoints either, which included surgical complications, heart attack, stroke, repeat revascularization and death.

To determine when potential complications would occur, the researchers also performed graft angiography at one week after surgery, for which they found the two grafts also performed equally, at 99 percent for the radial artery and 97 percent for the saphenous vein.

Also, Goldman reported “no difference” in quality of life at three months and one year. He told Cardiovascular Business News that while the quality of life outcomes were not improved, it’s difficult to assess “quality of life outcomes after surgery because the baseline is so far down.”

Finally, in a cost analysis, the researchers found that the total cost of the radial artery was $57,105 ($13,629, surgical costs) and total cost of the saphenous vein was $54,681 ($12,484, surgical costs). 

Goldman said that while “there will undoubtedly be a learning curve with this procedure, as with any other novel procedure, there was no difference across the eleven centers in terms of complications. All the surgeons involved in the trial received on-the-job training.”

He added that some surgeons use this as a “marketing technique,” employing the concept their practice is unique in offering arterial grafts.

According to Goldman, some surgeons believe the radial artery is superior to the saphenous vein because arterial grafts develop less disease than vein grafts and are better able to withstand aortic pressure.

In addition, the left internal mammary artery is commonly used in CABG and has shown positive results in published studies. However, Goldman explained that a procedure using the left internal mammary artery is “very different, and can be much more complicated than a procedure using the radial artery,” because the former requires reattaching only one end of the artery, while the latter requires total transplantation.

“While the study findings raise new questions from the surgical perspective regarding graft durability in the short term, we need to see the data from our study of long-term graft patency – which analyzes five-year outcomes – before making substantive judgments on the performance of the radial artery graft,” Goldman said.

The study was funded by the Department of Veterans Affairs Cooperative Studies program.