Interdisciplinary cardiovascular and thoracic surgery
September 1, 2026 · via Europe PMC
Surgical Outcomes of in situ Internal Thoracic Artery Grafting in Patients with Ipsilateral Upper-Extremity Arteriovenous Fistulas.
Chukwudi C, Singh R, Mansur A, +6 more, Osho AA.
AI summary — for doctors, generated from the abstract only
In dialysis patients undergoing CABG, in situ ITA grafting ipsilateral to an upper-extremity AV fistula was not associated with worse MACCE or 3-year mortality.
What was studied
Two-institution retrospective cohort of 122 dialysis-dependent CABG patients (66 ipsilateral in situ ITA vs 56 contralateral/free ITA), 2015-2023.
Key findings
- MACCE 39% ipsilateral vs 50% contralateral/free (P=.24) over median 2.4 years
- 3-year mortality 29% vs 21% (P=.352)
- Adjusted OR for MACCE 0.68 (P=.31); adjusted HR for mortality 1.56 (P=.291)
Clinical relevance
This hypothesis-generating finding suggests ipsilateral ITA use may be acceptable, but the modest sample cannot exclude coronary steal effects.
Who should care
Limitations
Modest retrospective cohort with limited power and wide confidence intervals.
An ipsilateral fistula didn't clearly harm ITA grafts in this small study, but larger data are needed.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
The use of in situ internal thoracic artery (ITA) grafts ipsilateral to upper extremity arterio-venous fistulas (UE-AVFs) during coronary artery bypass grafting (CABG) in dialysis-dependent patients raises concerns of coronary steal and compromised graft perfusion. However, the clinical significance of ITA-AVF laterality remains uncertain.
Methods
We retrospectively analysed dialysis-dependent patients who underwent CABG between February 2015 and December 2023 at 2 institutions. Patients with non-UE-AVF access, total vein grafting, or composite vein-artery configurations were excluded. The final cohort (N = 122) was divided into 2 groups: ipsilateral in situ ITA grafts (N = 66) and contralateral in situ or free ITA grafts (N = 56). The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE); secondary outcomes included perioperative complications, haemodialysis-induced ischaemia, and 3-year survival.
Results
Baseline and operative characteristics were largely comparable between groups. Perioperative outcomes, including surgical site infection, 30-day mortality, and prolonged ventilation, showed no significant differences. Over a median follow-up of 2.4 years, MACCE occurred in 44% of patients (39% ipsilateral vs 50% contralateral/free ITA; P = .24), with no significant differences in 3-year mortality (29% vs 21%; P = .352). Multivariable analyses showed no association between ITA-AVF laterality and MACCE (adjusted odds ratio 0.68, P = .31) or 3-year mortality (adjusted hazard ratio 1.56, P = .291).
Conclusions
In this modestly sized retrospective cohort, ipsilateral in situ ITA grafting was not associated with significantly worse perioperative or long-term outcomes. Our findings should be interpreted as hypothesis-generating, and larger multicentre studies are needed to more definitively evaluate the safety of this grafting strategy in dialysis-dependent patients with UE-AVFs.
DOI
10.1093/icvts/ivag231
PMID
42644803
PMCID
PMC13541775
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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