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BioMed Research International 2021We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences... (Review)
Review
We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.
Topics: Coronary Angiography; Coronary Artery Bypass; Humans; Radial Artery; Tomography, X-Ray Computed; Treatment Failure; Vascular Patency
PubMed: 33928147
DOI: 10.1155/2021/5528006 -
Seminars in Plastic Surgery Feb 2018Advances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized... (Review)
Review
Advances in our understanding of the lymphatic system and the pathogenesis of lymphedema have resulted in the development of effective surgical treatments. Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes into an extremity to restore physiological lymphatic function. It is most commonly performed by transferring combined deep inferior epigastric artery perforator and superficial inguinal lymph node flaps for postmastectomy breast reconstruction. For patients who do not require or are unable to undergo free abdominal breast reconstruction or have lymphedema affecting the lower extremity, several other VLNT options are available. These include flaps harvested from within the axillary, inguinal, or cervical lymph node basins, and lymph node flaps from within the abdominal cavity. This article reviews the lymph node flap options and techniques available for VLNT for lymphedema.
PubMed: 29636651
DOI: 10.1055/s-0038-1632401 -
The Journal of Thoracic and... Apr 2022We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal...
OBJECTIVES
We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (RITA) composite grafts.
METHODS
From 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or RITA (RITA group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the RITA group (n = 152). The 10-year angiographic occlusion rates and long-term clinical outcomes were compared. The follow-up data were complete for all 304 patients (100%) with a median follow-up of 143.7 months.
RESULTS
The early clinical outcomes were similar between the matched groups. The overall graft occlusion rate was 9.5% at 10 years in the matched group patients (matched RGEA and RITA groups, 10.3% and 8.4%, respectively; P = .639). The 10-year occlusion rates of the second-limb conduits showed no differences between the matched RGEA and RITA groups (14.1% and 10.2%, respectively; P = .487). No statistically significant differences were found at 15 years postoperatively in the overall survival (52.9% vs 49.4%; P = .470), cardiac mortality-free survival (92.1% vs 90.9%; P = .560), freedom from target vessel revascularization (83.0% vs 91.4%; P = .230), freedom from reintervention (68.8% vs 76.2%; P = .731), or freedom from major adverse cardiac and cerebrovascular events (56.4% vs 64.6%; P = .364) rates between the matched groups.
CONCLUSIONS
Total arterial revascularization using RGEA composite grafts showed comparable results to those using RITA composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.
Topics: Aged; Coronary Artery Disease; Female; Follow-Up Studies; Gastroepiploic Artery; Graft Occlusion, Vascular; Humans; Male; Matched-Pair Analysis; Middle Aged; Myocardial Revascularization; Retrospective Studies; Thoracic Arteries; Vascular Patency
PubMed: 32739170
DOI: 10.1016/j.jtcvs.2020.05.096 -
The Journal of Thoracic and... Apr 2022
Topics: Arteries; Coronary Artery Bypass; Gastroepiploic Artery; Humans
PubMed: 32736864
DOI: 10.1016/j.jtcvs.2020.06.040 -
The Korean Journal of Thoracic and... Aug 2016Throughout its 30-year history, the right gastroepiploic artery (GEA) has been useful for in situ grafts in coronary artery bypass grafting (CABG). The early graft... (Review)
Review
Throughout its 30-year history, the right gastroepiploic artery (GEA) has been useful for in situ grafts in coronary artery bypass grafting (CABG). The early graft patency rate is high, and the late patency rate has improved by using the skeletonized GEA graft and proper target selection, which involves having a target coronary artery with a tight >90% stenosis. Total arterial revascularization with the internal thoracic artery and GEA grafts is an option for achieving better outcomes from CABG procedures.
PubMed: 27525230
DOI: 10.5090/kjtcs.2016.49.4.225 -
JACC. Basic To Translational Science Apr 2021Coronary artery bypass graft (CABG) is the gold standard for coronary surgical revascularization. Retrospective, prospective, and meta-analysis studies looking into... (Review)
Review
Coronary artery bypass graft (CABG) is the gold standard for coronary surgical revascularization. Retrospective, prospective, and meta-analysis studies looking into long-term outcomes of using different conduits have pointed to the superiority of arterial grafts over veins and have placed the internal mammary artery as the standard conduit of choice for CABG. The superiority of the internal mammary artery over other conduits could be attributable to its intrinsic characteristics; however, little is known regarding the features that render some conduits atherosclerosis-prone and others atherosclerosis-resistant. Here, an overview is provided of the available data on the most commonly used conduits in CABG (internal mammary artery, saphenous vein, radial artery, gastroepiploic artery), highlighting the differences in their cellular biology, mechanical, biochemical, and vasoconstrictive properties. This information should help in furthering our understanding of the clinical outcomes observed for each of these conduits.
PubMed: 33997524
DOI: 10.1016/j.jacbts.2020.11.015 -
The Journal of Thoracic and... Apr 2022
Topics: Coronary Artery Bypass, Off-Pump; Gastroepiploic Artery; Internal Mammary-Coronary Artery Anastomosis; Mammary Arteries
PubMed: 32713645
DOI: 10.1016/j.jtcvs.2020.06.039