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Radial artery for myocardial revascularization: long-term clinical and angiographic results
A L Iacò1, G Teodori, G Di Giammarco
1Department of Cardiology, University G D'Annunzio, Chieti, Italy.
Insights
Radial artery (RA) grafts demonstrate satisfying long-term clinical outcomes in coronary artery bypass surgery. Angiographic patency exceeds 90% at 48 months, comparable to internal mammary arteries.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting (CABG)
Background:
- The radial artery (RA) is increasingly utilized as a conduit in coronary artery bypass surgery.
- Evaluating the long-term efficacy of RA grafts is crucial for surgical practice.
Purpose of the Study:
- To assess the long-term clinical and angiographic outcomes of using the radial artery as a graft in coronary artery bypass surgery.
Main Methods:
- A cohort of 164 patients received radial artery grafts between July 1992 and July 1994.
- Patients were divided into two groups: Group A (RA connected to left internal mammary artery) and Group B (RA connected to ascending aorta).
- Clinical and angiographic data were collected, including early mortality, long-term survival, event-free survival, and graft patency rates.
Main Results:
- Early mortality was low at 1.8%.
- Eight-year survival was 83.2% and event-free survival was 80.1%.
- Angiographic patency of radial artery distal anastomoses was high, exceeding 95% at a mean follow-up of 48 months, with no significant difference between groups.
Conclusions:
- Radial artery grafting yields satisfying long-term clinical results in coronary artery bypass surgery.
- High angiographic patency rates, comparable to internal mammary arteries, support its use.
- The location of the proximal anastomosis does not impact early or late graft patency.
Background:
To evaluate the long-term clinical and angiographic results of the radial artery (RA) as a graft in coronary artery bypass surgery.
Methods:
One hundred sixty-four patients had a RA graft from July 1992 to July 1994. In 128 (group A) the RA was connected end to side (115) or end to end (13) to the left internal mammary artery. In 36 (group B) the proximal anastomosis was on the ascending aorta.
Results:
Early mortality was 1.8% (group A 1.6% and group B 2.8%). Eight-year survival was 83.2%+/-3.2% (group A 82.1%+/-3.8% and group B 86.7%+/-6.2%, p = not significant [NS]), and event free survival was 80.1%+/-3.5% (group A 79.9%+/-4.4% and group B 80.2%+/-7.3%, p = NS). Sixty-one patients (37.2%) had an early angiography within 90 days from the operation. Patency rate of RA distal anastomoses were 98.9% (88 of 89), 98.7% in group A (77 of 78), 100% in group B (11 of 11; p = NS). After a mean of 48+/-27 months (6 to 96), 72 patients (51.1% of the survivors) had a new angiography. Patency rate of RA distal anastomoses was 95.6% (87 of 91), 93.8% in group A (61 of 65) and 100% in group B (26 of 26; p = NS). All the intermediate RA-LIMA anastomoses were patent at the early and late control. Patency rate for RA and IMAs was similar both early (88 of 89 versus 82 of 82; p = NS) and after 48+/-27 months (87 of 91 versus 93 of 93; p = NS).
Conclusions:
Long-term clinical results after RA grafting are satisfying. Angiographic patency rate, both early and after 48 months, is higher than 90% and is similar to that obtained with internal mammary arteries. The site of the proximal anastomosis does not influence early and late patency.