Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: A Grade- Assessed Meta-Analysis of Randomized Controlled Trials

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Coronary artery disease undergoing coronary artery bypass grafting (CABG) (n=1219). Intervention: Radial artery graft vs. Saphenous vein graft. Primary outcome: Graft failure (composite of complete occlusion [TIMI flow grade 0] or functional occlusion/string sign [<1 mm diameter]) (OR 0.50, 95% CI 0.22-1.16, p=0.11).

Q: What does this research mean for the field?

Radial artery grafts do not significantly reduce overall graft failure compared to saphenous vein grafts in coronary artery bypass grafting, exhibiting lower complete occlusion but a higher risk of functional occlusion. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Muhammad Hamza; Aizaz Anwar Khalid; Syed Omar Omar Shah; Hasnain Wajeeh Saqib; Anoosha Ashfaq; Mahad Ahmad; Talha Bin Fazal; Ikram Ul Haq Chaudhry

doi:10.21203/rs.3.rs-10461608/v1

October 11, 2026Open Access

Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: A Grade- Assessed Meta-Analysis of Randomized Controlled Trials

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Key result

Radial artery grafts did not significantly reduce overall graft failure compared to saphenous vein grafts in CABG (12.4% vs 14.9%; OR 0.50, 95% CI 0.22-1.16, P=0.11).

Why the study?

This study was conducted to compare the long-term efficacy and clinical outcomes of radial artery versus saphenous vein grafts in CABG for non-left anterior descending coronary arteries.

Does radial artery grafting reduce graft failure (composite of complete or functional occlusion) compared to saphenous vein grafting in adult patients undergoing CABG for non-left anterior descending coronary arteries?

Key Points

To compare the long-term efficacy and clinical outcomes of radial artery versus saphenous vein grafts for non-left anterior descending coronary arteries in coronary artery bypass grafting.
Systematic review and random-effects meta-analysis following PRISMA guidelines searching databases through March 2026.
Analyzed 4 randomized controlled trials evaluating 1,219 grafts (621 radial artery and 598 saphenous vein grafts) with mean trial follow-up ranging from 0.91 to 6.35 years.
Assessed graft failure (composite of complete or functional occlusion), patency, all-cause mortality, and repeat revascularization using odds ratios and GRADE certainty ratings.
Overall graft failure did not differ significantly between radial artery and saphenous vein grafts (12.4% vs. 14.9%; OR, 0.50; 95% CI, 0.22–1.16; P = .11), with comparable patency rates (87.6% vs. 85.1%; OR, 1.98; 95% CI, 0.87–4.54; P = .11).
Clinical outcomes showed no significant differences in all-cause mortality (17.4% vs. 25.6%; OR, 0.66; 95% CI, 0.39–1.12; P = .13) or repeat revascularization (1.2% vs. 1.8%; OR, 0.65; 95% CI, 0.26–1.66; P = .37).

Study Design

Type

Meta-Analysis (n=1,219)

Multicenter

Yes

Structured PICO

Does radial artery grafting reduce graft failure (composite of complete or functional occlusion) compared to saphenous vein grafting in adult patients undergoing CABG for non-left anterior descending coronary arteries?

P

Population

1,219 evaluated grafts (621 radial artery and 598 saphenous vein grafts) from 4 RCTs of adult patients undergoing CABG for non-LAD coronary arteries, followed for a mean of 0.91 to 6.35 years.

I

Intervention

Radial artery (RA) graft for bypass of non-left anterior descending coronary arteries

C

Comparator

Saphenous vein graft (SVG) for bypass of non-left anterior descending coronary arteries

O

Outcome

Graft failure, defined as a composite of complete occlusion (TIMI flow grade 0) or functional occlusion (the 'string sign', defined as diffuse narrowing of the graft to < 1 mm in diameter), assessed via follow-up angiographycomposite

Main Result

Odds Ratio: 0.5 (95% CI 0.22–1.16)

Absolute Event Rate: 12.4% vs 14.9%

p-value: p=0.11

In non-LAD CABG, radial artery and saphenous vein grafts show no significant difference in overall graft failure, mortality, or repeat revascularization, as the lower rate of complete anatomical occlusion with radial arteries is offset by a 6-fold higher risk of functional occlusion (string sign).

Limitations

Very few RCTs (only 4) matched the inclusion criteria, most with small sample sizes.
Moderate to high between-study heterogeneity (I2 = 62.2% for primary outcome) and high sensitivity to the omission of a single outlier trial (Desai et al.).
Diverse age groups, sex distributions, and baseline characteristics across included trials may restrict external validity.
Potential publication bias due to omission of grey literature and unpublished data.
Participant drop-out in some included RCTs.
Search was limited to studies published by the year 2020.
Very few RCTs (4) matched the inclusion criteria and most used small sample sizes
Moderate to high statistical heterogeneity across included studies
Diverse age groups, sex distributions, and baseline characteristics across RCTs may restrict external validity
Potential publication bias due to omission of grey literature and unpublished data
Participant drop-out in some included RCTs contributing to attrition bias

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Answers are grounded in this paper and cite their sources.

Implication

Does not support preferential radial artery use over saphenous vein in CABG; confirms equivalent overall patency in randomized data.

Abstract

Background This systematic review and meta-analysis compared the long-term efficacy and clinical outcomes of radial artery (RA) versus saphenous vein grafts (SVG) in coronary artery bypass grafting (CABG). Methods Following PRISMA guidelines, databases were searched through March 2026 for randomized controlled trials (RCTs) comparing RA and SVG for non-left anterior descending coronary arteries. The primary outcome was graft failure, defined as a composite of complete or functional occlusion (string sign). Results Four RCTs assessing 1,219 grafts (621 RA; 598 SVG) were included. No statistically significant differences were found between RA and SVG in overall graft failure (12.4% vs. 14.9%; P = .11) or patency rates (87.6% vs. 85.1%; P = .11). However, RA grafts demonstrated significantly lower odds of complete occlusion (7.1% vs. 13.9%; P = .046) but a 6-fold higher risk of functional occlusion (6.1% vs. 0.8%; P < .001). Leave-one-out sensitivity analysis revealed that omitting one outlier study eliminated heterogeneity and shifted primary outcomes significantly in favor of RA grafts. No significant differences were observed for all-cause mortality (P = .13) or repeat revascularization (P = .37). Conclusion Neither conduit is universally superior. RA grafts reduce complete anatomical occlusion but are highly susceptible to competitive flow-induced functional occlusion. Graft selection should be individualized based on patient demographics and target vessel characteristics.

Discussion

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Cite This Study

Hamza et al. (2026) conducted a meta-analysis in Coronary artery disease undergoing coronary artery bypass grafting (CABG) (n=1,219). Radial artery graft vs. Saphenous vein graft was evaluated on Graft failure (composite of complete occlusion [TIMI flow grade 0] or functional occlusion/string sign [<1 mm diameter]) (OR 0.50, 95% CI 0.22-1.16, p=0.11). Radial artery grafts did not significantly reduce overall graft failure compared to saphenous vein grafts in CABG (12.4% vs 14.9%; OR 0.50, 95% CI 0.22-1.16, P=0.11).

synapsesocial.com/papers/6aee6b6871a759480622090c https://doi.org/10.21203/rs.3.rs-10461608/v1

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Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: A Grade- Assessed Meta-Analysis of Randomized Controlled Trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: A Grade- Assessed Meta-Analysis of Randomized Controlled Trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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