Current Issues in Coronary Revascularization for Hemodialysis Patients

Coronary artery bypass grafting (CABG) is advantageous for long-term clinical outcomes compared to percutaneous coronary intervention (PCI) in hemodialysis (HD) patients, as PCI has a lower short-term mortality but higher late revascularization risk. Therefore, CABG is very important for HD patients in current clinical practice. In HD patients, the presence of an arteriovenous fistula may lower the flow capacity of the ipsilateral internal thoracic artery (ITA) and induce flow steal, and concomitant microvascular disease (MVD) can cause myocardial ischemia and irreversible myocardial damage even after CABG. The use of the ipsilateral ITA as a free graft or the contralateral ITA as a graft to the left anterior descending artery can be reasonable options. MVD complicates the preoperative evaluation and could worsen clinical outcomes in HD patients. Graft selection and MVD in coronary and systemic circulation are mutually influential future concerns.