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Do coronary artery bypass grafts using cephalic veins have a satisfactory patency?

^a Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital, Blackpool, UK
^b Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel/fax: +44-780-1548122.

E-mail address: joeldunning{at}doctors.org.uk (J. Dunning).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether using the cephalic vein from the arm for coronary artery bypass grafts achieves an adequate patency rate. Only 219 papers were identified on Medline using the reported search and hand-searching of reference lists. Fourteen papers represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. The patency rate seems to be in the order of 50% at around three years for cephalic veins used for coronary bypass grafting, and this was variable. In addition, we identified only 181 cephalic veins used for coronary bypass grafting in the literature from seven papers. In lower extremity bypass procedures over 900 uses of the cephalic vein have been documented but again patency seems to be around 50% at three to five years. Arterialisation of the vein using an arteriovenous fistula, or angioscopy, have both been used as an attempt to improve patency. In addition, a large proportion of the reported cephalic veins for coronary grafting were used for sequential bypass grafting which may have affected patency rates. Thus, in summary, the patency of the cephalic vein used for coronary artery bypass grafting is around 50% at three years.

Key Words: Thoracic surgery; Cephalic vein; Upper extremity vein; Graft patency

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