Which statement best reflects the impact of using arterial grafts, such as LIMA, on long-term CABG outcomes?

• A. Arterial grafts are associated with better long-term patency and outcomes.
• B. Arterial grafts are associated with higher stroke risk and worse patency.
• C. Arterial grafts have no impact on long-term outcomes.
• D. Arterial grafts are seldom used.

Answer: (A)

Using arterial grafts, particularly the left internal mammary artery to the LAD, tends to stay open much longer than vein grafts. Arteries are built to handle high-pressure arterial blood flow and resist atherosclerotic change better than veins that are repurposed for arterial use. This durability translates into higher long-term patency rates and fewer graft failures over years, which means fewer episodes of recurrent angina, fewer need for repeat revascularization, and improved survival in the long run. Because the LAD territory is so critical, the benefit is especially pronounced when the graft is placed there, reinforcing why arterial grafting shows better long-term outcomes overall.

The other statements don’t align with the real pattern seen in CABG practice. Arterial grafts are not associated with a higher stroke risk by virtue of the graft choice, nor do they have no impact on long-term outcomes, and they are not rarely used in modern surgery.