Total Arterial (CABG)
Total Arterial Coronary Artery Bypass Grafting (CABG) is an advanced surgical technique that uses only arterial grafts—rather than veins—to bypass blocked coronary arteries, ensuring superior long-term patency and clinical outcomes.
Why Choose Arteries Over Veins?
In conventional CABG, surgeons usually use a mix of venous and arterial grafts (most commonly the saphenous vein and internal mammary artery).
When only arteries are used to bypass the diseased arteries the new ‘conduits’ or grafts made of arteries remain patent longer – that means fresh disease does not develop in the new pathways made to carry the blood to the heart muscles and thus patients remain free of symptoms longer and chances of requiring a second bypass operation decreases significantly.
Common Arteries Used in Total Arterial CABG
Left Internal Mammary Artery (LIMA): This artery, located inside the chest, is the most reliable graft used to bypass the left anterior descending (LAD) artery.
Right Internal Mammary Artery (RIMA): Often used alongside LIMA for multiple grafts, providing superior long-term results.
Radial Artery: Taken from the arm, it serves as an excellent additional graft due to its good size and flow characteristics.
Gastroepiploic Artery: Occasionally used for specific grafts in patients needing extensive revascularization.
How Total Arterial CABG Is Performed
During the procedure, the surgeon harvests arteries—usually from the chest and arm—using conventional or skeletonized harvesting techniques to improve reach and minimize wound complications. These are then joined with each other in many
various combinations such that all the diseased arteries are now getting blood through graft arteries.
Benefits of Total Arterial CABG
Total Arterial CABG offers several advantages over conventional bypass surgery:
Long term graft durability: Arterial grafts often last over 15–20 years, with studies showing over 90% patency at 10 years and over 80% at 15 years.
Better heart function: Improved blood flow enhances oxygen supply and cardiac performance.
Lower risk of reoperation: Patients experience fewer blockages and less need for future surgeries.
Superior survival rates: Studies show that total arterial revascularization improves long-term survival and quality of life.
Enhanced resistance to disease: Arteries are less likely to develop new blockages compared to veins.
Who Is a Candidate for Total Arterial CABG?
This surgery is ideal for younger patients, diabetics, and those requiring multiple grafts or complete revascularization. It is also preferred when long-term graft durability is desired.
However, the choice depends on overall health, artery quality, and the surgeon’s expertise. Bilateral internal mammary artery (BIMA) grafting provides maximum survival benefit but may slightly increase sternal wound risk in diabetics or obese patients.
Recovery After Total Arterial CABG
Recovery is similar to standard CABG surgery, though arterial grafts are associated with fewer long-term complications and better overall heart function.
Risks and Considerations
Although Total Arterial CABG offers excellent outcomes, it requires specialized expertise, meticulous technique, and precise handling of arterial conduits to prevent spasm and ensure long-term patency.
Please discuss with your surgeon about feasibility of Total Arterial Bypass and individual risk associated with it, if you are advised a bypass operation.
Total Arterial vs. Conventional CABG
Traditional CABG uses both veins and arteries, while Total Arterial CABG relies solely on arteries. Minimally invasive and robotic surgical approaches are now being increasingly adopted to perform total arterial revascularization with smaller incisions and faster recovery.
Regular follow-up with cardiac imaging (CT angiography or stress testing) helps monitor long-term graft patency and overall cardiac health.
Frequently Asked Questions
What is Total Arterial CABG?
Total Arterial CABG is a bypass surgery in which only arteries (LIMA, RIMA, Radial artery) are used to create all grafts instead of veins. Arterial grafts are stronger, last longer, and provide excellent long-term results.
How is Total Arterial CABG different from conventional CABG?
Conventional CABG uses:
1 or 2 arterial grafts
Remaining grafts from leg veins
Total Arterial CABG uses 100% arterial grafts, which have superior durability and patency.
Why are arterial grafts better than vein grafts?
Because arteries have:
Stronger walls
Better resistance to blockages
Ability to adapt to blood flow
Long-term patency of 90–95% even after 10–15 years
Vein grafts may start narrowing earlier.
Who should consider Total Arterial CABG?
It is especially beneficial for:
Patients < 70 years
Diabetics
Patients with multiple blockages
Patients expecting long lifespan
Patients with failed previous vein grafts
Is Total Arterial CABG safe?
Yes. When performed by experienced surgeons, it is as safe as traditional CABG and often provides superior long-term outcomes.
Is the recovery time different from regular CABG?
Recovery is usually similar—4–5 days hospital stay and 6–8 weeks complete recovery.
However, long-term benefits are significantly better.
How long do arterial grafts last?
Most arterial grafts last 15–25 years, often longer.
LIMA grafts can remain open for a lifetime in many patients.
Is Total Arterial CABG more time-consuming?
Slightly, yes. It requires higher surgical expertise and more precise harvesting.
But this extra effort results in better long-term survival.
Are lifestyle changes still needed after Total Arterial CABG?
Absolutely. Even the best grafts need:
No smoking
Good BP and sugar control
Healthy diet
Regular exercise
Strict medication adherence
Can every patient undergo Total Arterial CABG?
Not always. Patients with certain artery conditions (e.g., weak radial artery, subclavian issues) may not be suitable.
Your surgeon decides based on clinical evaluation.
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