Total Arterial Bypass: Operations Performed Using Arteries Only

The choice of graft (bridging vessel) that we use in bypass surgery directly affects the long-term success of the operation. While in the classic method a vein taken from the leg (the saphenous vein) is frequently used, in some of our patients we perform all the bypasses using arteries (arterial grafts) only. In this article I will explain total arterial bypass and in whom we prefer it.

Using Arm and Chest Arteries Instead of the Leg Vein

In addition to the mammary artery on the inner surface of the chest (LIMA/RIMA), we can also use the radial artery in the forearm as a graft. In total arterial bypass we suture only these arteries, rather than a vein taken from the leg, to all the blocked vessels; unlike veins, arteries are by their structure more resistant to high pressure and have a lower tendency to become blocked over time.

Long-Term Patency Rates of Arterial Grafts

The largest randomised trial on this subject, the Arterial Revascularization Trial (ART), showed that using both mammary arteries did not create a significant difference in 10-year overall survival compared with using one, but that survival was in fact better in patients who received two or more arterial grafts. This finding has taught us that increasing the number of arterial grafts can offer a valuable long-term advantage in the right patient.

Why Is Total Arterial Bypass Not Performed in Every Patient?

Because using both mammary arteries somewhat reduces the blood flow to the breastbone, it can increase the risk of breastbone infection, especially in diabetic and severely overweight patients; for this reason we carefully assess the patient’s risk profile when choosing this technique. In addition, the radial artery graft has its own particular technical requirements and limitations.

Frequently Asked Questions

Is total arterial bypass suitable for everyone? No; factors such as diabetes, excess weight and the risk of breastbone infection affect this decision.

How long do arterial grafts last? Mammary artery grafts are the most reliable grafts in bypass surgery and can stay open for decades in the right patient.

If the radial artery is taken, will there be a problem in the arm? Because the arm is also supplied by another artery, the radial artery can be taken safely in suitable patients.

Conclusion

Total arterial bypass is a specialised technique that offers a valuable long-term advantage in the right patient, but it is not applied to every patient. The decision is personalised according to the patient’s vascular structure, additional diseases and graft requirements.

You can make an appointment for a detailed examination to assess which graft strategy is suitable for you in your bypass operation.

References

1. Arterial Revascularization Trial Investigators. Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. N Engl J Med. 2019;380(5):437-446.
2. Gaudino M, Audisio K, Rahouma M, et al. Effect of Total Arterial Grafting in the Arterial Revascularization Trial. J Thorac Cardiovasc Surg. 2022;163(2):610-618.