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Correspondence

Is an Arterial Conduit Really Better?

St. John's Mercy Medical Center, Department of Surgery, Suite R-7040, 625 South New Ballas Rd, St. Louis, MO 63141

(Email: ebsavage2{at}hotmail.com).

To the Editor:

Schwann and colleagues [1] have attempted to demonstrate the superiority of the radial artery relative to a saphenous vein as a conduit to a vessel that has been enlarged with an endarterectomy. Based on recent reports in the literature, I too consider the use of the radial artery in certain scenarios superior to a vein graft. However, I have some concerns about the statistical analysis performed in this article. First, the authors note that radial artery grafts were used preferentially to bypass high-grade stenoses (> 75%) to minimize failure due to competitive flow. Competitive flow has a similar, although less pronounced effect on vein graft patency and may have impacted their results. This selection bias was not accounted for in the statistical analysis. Second, one must assume, because the distribution is not presented, that more radial arteries were used relative to veins in the more recent time period. This may have coincided with the transition from warfarin to clopidogrel to maintain patency. I do not find reference to the inclusion of anticoagulation regimen in the multivariable analysis. Third, no reference is made to distribution by surgeon. Of the six authors, five are surgeons. Were these evenly distributed by surgeon or performed by one surgeon? If one surgeon used all radial arteries and the other saphenous vein, is the difference the choice of graft or the surgeon?

This is a very important article, particularly the information presented regarding the right coronary system. However, before conclusions regarding the superiority of the radial artery can be drawn, these important confounding factors need to be addressed. I commend the authors for an important and fine article and look forward to their response.

	References

Top References

 

1. Schwann TS, Zacharias A, Riordan CJ, Durham SJ, Shah AS, Habib RH. Survival and graft patency after coronary bypass grafting with coronary endarterctomy: role of arterial versus vein conduits Ann Thorac Surg 2007;84:25-31.[Abstract/Free Full Text]

This article has been cited by other articles:

				T. A. Schwann, A. Zacharias, C. J. Riordan, S. J. Durham, A. S. Shah, and R. H. Habib Reply Ann. Thorac. Surg., May 1, 2008; 85(5): 1839 - 1840. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Edward B. Savage Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Savage, E. B. Search for Related Content PubMed PubMed Citation Articles by Savage, E. B. Related Collections Coronary disease Related Article