Clinical classification of arterial grafts

Abstract

Various arterial grafts have been used for coronary artery bypass grafting. However, except for the internal mammary artery (IMA), which has been regarded as the choice for left anterior descending artery (LAD) grafting, so far there is no unanimous opinion as to the best use of other grafts. Arterial grafts, on the one hand, are all conductance arteries and therefore have features in common compared with venous grafts (see Chap. 3). On the other hand, they are found in different parts of the body and have a different physiological role because the organs they perfuse have a different physiological role. To meet the physiological requirements, these arteries have a different anatomic structure (see Chap. 1) and a different physiological and pharmacological reactivity to vasoactive substances. Furthermore, they are of different embryological origin [1]. Arterial grafts are therefore not uniform in their biological characteristics. As discussed in Chap. 3, the difference in the perioperative behavior of the grafts and in the long-term patency may be related to different characteristics. These should be taken into account in the use of arterial grafts, some of which require more active pharmacological intervention during and after operation to obtain satisfactory results. To better understand the biological behavior of the grafts, their common features and differences, a clinical classification may be useful for the practicing surgeon. © Springer-Verlag Berlin Heidelberg 2006.