Grafts
There are three main locations from which a provider can take the blood vessel to be used for a bypass procedure: the patient's arms, legs, or chest. The surgeon decides which one(s) to use based on a number of factors, including the location of the blockage, the amount of blockage, and the size of the patient's coronary arteries. Time is also a consideration: in an emergency situation, readily prepared vessels must be used. The durability of the vessel is another factor the surgeon must consider.

The most commonly used blood vessel for bypass is the saphenous vein of the leg. Because of its length, it can be used for triple- or quadruple-bypass bypass operations. However, arterial grafts tend to last longer than venous grafts. They withstand blood pressure better and are also less likely to develop occlusions (blockages). Ten years after CABG surgery, a full 90% of arterial grafts remain open compared to only 66% of vein grafts. The failure of vein grafts over the long term is the single greatest cause of the need for repeat bypass surgery. For these reasons, many surgeons prefer to use arterial grafts if possible.

Several arteries are used for grafting: the internal thoracic (also called internal mammary) artery of the chest, the gastro-epiploic artery of the stomach, the inferior epigastric artery of the abdomen, and the radial artery of the arm. Of these, the radial artery and the internal thoracic artery are the most frequently used. The radial artery is the artery you feel when you take your pulse in your wrist. Because there are two major arteries that supply blood to the arm, the radial artery can usually be removed without damaging blood flow to the arm. In addition, the radial artery is relatively easily removed and prepared as a graft. However, the radial artery has a higher rate of occlusion and graft failure than the internal thoracic artery. The internal thoracic artery, on the other hand, functions well as a graft, with a low rate of graft failure and occlusion. It is located in the chest and so doesn't require a second incision site. However, it must first be dissected from the chest wall and so can't be used in emergency situations. The internal thoracic artery is used for bypassing the left anterior descending artery. The gastro-epiploic artery is used relatively infrequently due to the difficulty of removing it from the abdomen.

More on this topic

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Stiff & Narrow
The Consequences of Clots
Testing & Diagnosis
Bypass Background
The Way to Your Heart
New Connections
Recovery from Bypass
Lifestyle for a Healthy Heart

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