Abstract
In coronary artery bypass grafting (CABG) for patients on hemodialysis, there has been concern about “coronary steal”. This study aims to evaluate the influence of using an in situ internal thoracic artery (ITA) ipsilateral to a preexisting arteriovenous fistula (AVF) in dialysis-dependent patients undergoing CABG. Between 2004 and 2018, dialysis-dependent patients with AVFs who underwent CABG were enrolled. According to the locational relationship of AVFs and in situ ITA grafts, the patients were divided into the ipsilateral group (n = 22) and the contralateral group (n = 21). Inverse probability weighting analysis was used to estimate and compare the late clinical outcomes. The late cardiac-related adverse events were not significantly different between the two groups: “major adverse cardiovascular and cerebrovascular events (MACCE)” (p = 0.090), “composite outcome of recurrent angina and coronary re-intervention” (p = 0.600). The in situ ITA graft of CABG on the ipsilateral side to AVF was not a significant risk factor for MACCE or the composite outcome of recurrent angina and coronary re-intervention. There was no statistically significant difference in the graft patency between the groups. Therefore, it might not be necessary to avoid using an in situ ITA on the ipsilateral side of an upper-arm AVF for optimal coronary artery bypass grafting in dialysis-dependent patients.
Highlights
In coronary artery bypass grafting (CABG) for patients dependent on hemodialysis, there has been concern about using an in situ internal thoracic artery (ITA) on the same side of an arteriovenous fistula (AVF)
Several studies have reported that angina could be aggravated during hemodialysis when an in situ ITA on the ipsilateral side of an AVF had been used for CABG [1,2,3]
The benefits of using an ITA have been demonstrated in patients with renal insufficiency, with several reports about early graft failures in CABG using saphenous vein grafts [4]
Summary
In coronary artery bypass grafting (CABG) for patients dependent on hemodialysis, there has been concern about using an in situ internal thoracic artery (ITA) on the same side of an arteriovenous fistula (AVF). Several studies have reported that angina could be aggravated during hemodialysis when an in situ ITA on the ipsilateral side of an AVF had been used for CABG [1,2,3]. Using an in situ ITA on the contralateral side of an AVF or performing aortocoronary bypass surgery with a saphenous vein graft is recommended. The benefits of using an ITA have been demonstrated in patients with renal insufficiency, with several reports about early graft failures in CABG using saphenous vein grafts [4]. Using an in situ right ITA can be considered an option in patients with an AVF on the left side
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
