How does the right gastroepiploic artery compare with the saphenous vein for revascularization of the right coronary artery?

A best evidence topic was written according to a structured protocol. The question addressed was 'is the saphenous vein graft or right gastroepiploic artery a better conduit for revascularization of the right coronary artery?' One hundred and five articles were found using a designated search, of which 10 articles were found to represent the best available evidence to answer the clinical question. Of these 10 articles, two were reports of a randomized controlled trial and represented the highest level of evidence, whereas eight articles were retrospective observational studies. All were published between 2002 and 2012. Outcome measures varied considerably, but mostly included graft patency at varying periods of follow-up. The randomized evidence suggested that the saphenous vein had better early (6-month) and mid-term (3-year) graft patency than the right gastroepiploic artery when used for right coronary artery revascularization. The use of the saphenous vein was also found to be predictive of superior graft function using multivariate regression; however, a more recent propensity score analysis identified gastroepiploic-right coronary grafts to yield superior very long-term (>10 years) clinical outcomes. Overall, based on the best quality evidence and in view of technical limitations and flow characteristics of the right gastroepiploic artery, it appears that saphenous vein grafts may offer superior outcomes for revascularization of the right coronary artery in most cases, and should be preferentially used.