WBR0992

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Cardiovascular
Prompt	A 50 year- old male comes to ED complaining of a dull pain started 15 min ago all over his chest that radiates to the left shoulder and arm. EKG is normal. After the resolve of his attack, you ordered a stress test, which turn abnormal and show a reversible ischemia. The patient was indicated for angiography which shows >70% stenosis in the left main coronary artery, and the patient indicated for CABG. Which of the following is the main difference between saphenous vein grafts and internal mammary artery grafts?
Answer A	Internal mammary artery grafts remain open for 10 years
Answer A Explanation	Correct Internal mammary artery grafts remain open for 10 years
Answer B	Saphenous vein grafts remain open for 10 years
Answer B Explanation	Incorrect Vein grafts started to be occluded after 5 years
Answer C	Heparin is necessary for vein grafts
Answer C Explanation	Incorrect There is no difference in the medication needs between saphenous vein grafts and internal mammary artery grafts.
Answer D	Anticoagulants is necessary with saphenous vein grafts
Answer D Explanation	Incorrect There is no difference in the medication needs between saphenous vein grafts and internal mammary artery grafts.
Answer E	Anti-platelets is less needed with Internal mammary grafts
Answer E Explanation	Incorrect There is no difference in the medication needs between saphenous vein grafts and internal mammary artery grafts.
Right Answer	A
Explanation	The main difference between Internal mammary artery grafts and saphenous vein grafts is in the occlusion period. Vein grafts started to be occluded after 5 years, while internal mammary aretry grafts are often patent at 10 years. There is no difference in the medication needs between them. Educational Objective: References:
Approved	No
Keyword	[[WBRKeyword::CABG]]
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