**5. The disadvantages of arterial grafts**

The sternum infection rates when using BIMA grafts is vastly variable. Lytle reports 2.5% incidence of inflammation of the sternotomy incision when using bilateral internal mammary arteries compared to 1.4% in the group of single internal mammary artery graft. [26] Grossi and colleagues [27] published an increase of the incidence of inflammation of the sternal incision when factor 2 exists and a lot higher rate of chances, increased by 13.9% when there is concurrent diabetes. Kouchoukos [28] published that other risk factors showing an increase of the inflammation are obesity, severe chronic obstructive pulmonary disease and prolonged mechanical ventilation.

Arterial grafts shall be avoided in patients with chronic renal dysfunction and those under‐ going dialysis (Steal syndrome from the AV fistula, limited survival due to dialysis.

Matsa [29] suggests the use of a skeletonized internal mammary artery (as this technique protects the collateral sternal blood flow). He argues that the complication rate of the sternal incision was the same in diabetic patients and in non-diabetic patients.

The competitive flow is the causal factor for the "string sign" which is rarely observed in arterial grafts. It had been reported when the vessel to be by-passed had not high grade stenosis. Thus, in order to avoid the competitive flow, arterial grafts are usually used only when stenosis is over 90%.


**Table 5.** Patency of various arterial grafts over time

Two prospective randomized control studies comparing the radial artery (RA) to other grafts by means of a full angiographic follow-up are the RAPS [24] (Radial Artery Patency Study) and RSVP (Radial artery versus Saphenous Vein Patency Study) and are still in progress.

The RAPCO (Radial Artery Patency and Clinical Outcome) [25] is a prospective random‐ ized study that compares the radial artery (RA) to grafts from the great saphenous vein and the free grafts from the right internal mammary artery. All patients received grafts from the LIMA to the LAD and then they were randomized and received either the radial artery or the right internal mammary artery on a second target in patients less than 70 years old and either the radial artery or the great saphenous vein (again within a second

The 5year angiographic patency of the radial artery and the right internal mammary artery was 95 and 100% respectively, and of the saphenous vein and the radial artery it was 87% and

The tendency for vasospasm is due to the thick muscle wall of the vessel. Prevention is achieved by fine handling and the use of focal agents during denudation (papaverine / phenoxybenz‐

The sternum infection rates when using BIMA grafts is vastly variable. Lytle reports 2.5% incidence of inflammation of the sternotomy incision when using bilateral internal mammary arteries compared to 1.4% in the group of single internal mammary artery graft. [26] Grossi and colleagues [27] published an increase of the incidence of inflammation of the sternal incision when factor 2 exists and a lot higher rate of chances, increased by 13.9% when there is concurrent diabetes. Kouchoukos [28] published that other risk factors showing an increase of the inflammation are obesity, severe chronic obstructive pulmonary disease and prolonged

Arterial grafts shall be avoided in patients with chronic renal dysfunction and those under‐

Matsa [29] suggests the use of a skeletonized internal mammary artery (as this technique protects the collateral sternal blood flow). He argues that the complication rate of the sternal

The competitive flow is the causal factor for the "string sign" which is rarely observed in arterial grafts. It had been reported when the vessel to be by-passed had not high grade stenosis. Thus, in order to avoid the competitive flow, arterial grafts are usually used only

going dialysis (Steal syndrome from the AV fistula, limited survival due to dialysis.

incision was the same in diabetic patients and in non-diabetic patients.

amine solutions) followed by amlodipine 5mgr x 1 for one year after surgery.

target) in patients aged over 70.

**4. Problems related to the radial artery**

**5. The disadvantages of arterial grafts**

94% respectively.

166 Artery Bypass

mechanical ventilation.

when stenosis is over 90%.
