What is the most patent CABG graft commonly used?

The left internal mammary artery (LIMA) is considered the most patent graft commonly used in coronary artery bypass grafting (CABG) procedures. Its high long-term patency rates stem from several factors, including its robust blood flow characteristics and resistance to atherosclerosis compared to saphenous vein grafts. This artery has been shown to have significantly better graft survival rates over the years due to its native arterial qualities that better match the characteristics of coronary arteries.

Using the LIMA for bypassing the left anterior descending (LAD) artery has become a standard practice because of its favorable outcomes, including lower rates of occlusion and the fact that it is less prone to the negative effects of the systemic disease that affects veins. This artery is dissected from the chest wall and can be mobilized without compromising blood flow to the breast or chest wall tissues, further underscoring its utility.

In contrast, while other grafts such as saphenous vein grafts (SVG) and radial arteries (RAD) have their roles in CABG, they do not match the LIMA in terms of long-term patency and effectiveness. The right internal mammary artery (RIMA) can also be used, but its adoption is less common