[Arterial grafts in coronary surgery. Treatment for everyone?]. / Los injertos arteriales en cirugía coronaria: una terapia universal?

At present, arterial conduits are the key elements of coronary bypass surgery. The clear benefits of using the left internal mammary artery for revascularization of the left anterior descending coronary artery have encouraged the use of other arteries in different areas. The right internal mammary artery and the radial artery are competing for the role as the second most useful conduit. Moreover, use of the right gastroepiploic artery or the inferior epigastric artery, although both are less popular, enables complete revascularization to be carried out using only arterial grafts in most patients. The majority of publications on the subject endorse the extensive use of arterial conduits. However, most findings are based on observational and angiographic data that are derived essentially from studies on symptomatic patients. Consequently, indications for the different techniques have not been standardized. On the other hand, the patency of saphenous vein grafts has improved recently. This article describes the anatomical and histologic characteristics of arterial conduits. The indications for, and advantages and limitations of, the different techniques available are reviewed. In addition, the clinical and angiographic results achieved are considered, as is the role of arterial conduits in different anatomical and clinical settings. Finally, the future application of this type of surgery is discussed.

Los injertos arteriales en cirugía coronaria: ¿una terapia universal? / Arterial grafts in coronary surgery. Treatment for everyone?

Los conductos arteriales son, hoy día, elementos fundamentales de la cirugía coronaria. Las indiscutibles ventajas de la revascularización de la descendente anterior con la arteria mamaria izquierda han impulsado la utilización de otras arterias en territorios diferentes. La arteria mamaria derecha y la arteria radial se disputan el papel de segundo conducto. Además, la arteria gastroepiploica derecha y la epigástrica inferior, aunque menos populares, permiten conseguir una revascularización completa utilizando exclusivamente injertos arteriales en la mayoría de los pacientes. La mayoría de las publicaciones al respecto avalan el uso extensivo de los conductos arteriales. Sin embargo, gran parte de esta información está basada en estudios observacionales y los datos angiográficos se refieren fundamentalmente a pacientes sintomáticos, por lo que las indicaciones de las diferentes técnicas no están estandarizadas. Por otra parte, la permeabilidad de los injertos de vena safena en nuestros días ha mejorado con respecto a la de épocas anteriores. En este artículo se describen las características anatómicas e histológicas de los conductos arteriales. Se comentan las diferentes opciones técnicas con sus indicaciones, ventajas e inconvenientes. También se analizan los resultados, tanto clínicos como angiográficos, y el papel de los injertos arteriales en los distintos escenarios anatómicos y clínicos. Por último, se discuten las perspectivas futuras de este tipo de cirugía

At present, arterial conduits are the key elements of coronary bypass surgery. The clear benefits of using the left internal mammary artery for revascularization of the left anterior descending coronary artery have encouraged the use of other arteries in different areas. The right internal mammary artery and the radial artery are competing for the role as the second most useful conduit. Moreover, use of the right gastroepiploic artery or the inferior epigastric artery, although both are less popular, enables complete revascularization to be carried out using only arterial grafts in most patients. The majority of publications on the subject endorse the extensive use of arterial conduits. However, most findings are based on observational and angiographic data that are derived essentially from studies on symptomatic patients. Consequently, indications for the different techniques have not been standardized. On the other hand, the patency of saphenous vein grafts has improved recently. This article describes the anatomical and histologic characteristics of arterial conduits. The indications for, and advantages and limitations of, the different techniques available are reviewed. In addition, the clinical and angiographic results achieved are considered, as is the role of arterial conduits in different anatomical and clinical settings. Finally, the future application of this type of surgery is discussed

La operación de Ross: teóricamente ideal, pero ¿ventajosa en la práctica? / Ross operation: attractive in theory but, Is it superior in daily practice?

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