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.