Review
Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

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Spasm of arterial grafts in coronary artery bypass grafting surgery is still a clinical problem, and refractory spasm can occasionally be lethal. Perioperative spasm in bypass grafts and coronary arteries has been reported in 0.43% of all coronary artery bypass grafting surgery, but this may be an underestimate. Spasm can develop not only in the internal mammary artery but more frequently in the right gastroepiploic and radial artery. The mechanism of spasm can involve many pathways, particularly those involving regulation of the intracellular calcium concentration. Endothelial dysfunction also plays a role in spasm. Depending on the clinical scenario, the possibility of spasm during and after coronary artery bypass grafting should be confirmed by angiography. If present, immediate intraluminal injection of vasodilators is often effective, although other procedures such as an intraaortic balloon pump or extracorporeal membrane oxygenation may also become necessary to salvage the patient. Prevention of spasm involves many considerations, and the principles are discussed in this review article.

Section snippets

Clinical Classification of Arterial Grafts

To better understand the differing biologic behavior of arterial grafts, a clinical classification may be useful for the practicing surgeon. Based on experimental studies of their vasoreactivity combined with anatomic, physiologic, and embryologic considerations, a functional classification for arterial grafts has been proposed that suggests there are three types of arterial grafts: type I, somatic arteries; type II, splanchnic arteries; and type III, limb arteries 19, 32.

Type I arteries, such

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