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Effect of target stenosis and location on radial artery graft patency
Hersh S Maniar1, Thoralf M Sundt, Hendrick B Barner
1Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA.
Insights
Radial artery graft patency depends on target vessel stenosis and location. Use the radial artery selectively for left anterior descending and circumflex targets, avoiding those with moderate stenosis or in the right coronary artery distribution to minimize failure risk.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting
Background:
- The internal thoracic artery-radial artery composite T graft is utilized in coronary bypass surgery.
- Evaluating target vessel characteristics is crucial for optimizing graft patency.
Purpose of the Study:
- To assess how target vessel properties influence the patency of radial artery grafts used in composite T grafts.
- To identify factors affecting radial artery anastomotic success in coronary artery bypass grafting.
Main Methods:
- Analysis of 231 radial artery anastomoses from 109 patients who underwent coronary bypass with composite T grafts.
- Utilized Cox proportional hazard models to evaluate anastomotic patency based on target vessel location, stenosis severity, diameter, and quality.
- Angiography performed at a mean of 27.1 months postoperatively for patients experiencing ischemic symptoms.
Main Results:
- Higher mean stenosis (82%) in patent anastomoses compared to occluded ones (71%).
- Worse patency for targets with moderate stenosis (<=70%) versus critical stenosis (>=90%).
- Radial artery targets in the right coronary artery distribution showed inferior patency compared to the left anterior descending artery.
Conclusions:
- Radial artery graft patency is significantly influenced by target vessel location and the degree of proximal stenosis.
- Selective use of radial artery grafts to targets in the left anterior descending and circumflex artery distributions is promising.
- Radial artery grafts to the right coronary artery or targets with moderate stenosis exhibit a high risk of failure.
Objective:
The purpose of this study was to evaluate the effect of target vessel characteristics on radial artery patency when used as a composite T graft.
Methods:
Between October 1993 and March 2001, 1022 patients underwent coronary bypass with the internal thoracic artery-radial artery composite T graft. Of these, angiography has been performed on 109 patients at a mean 27.1 months (range, 2-70 months) postoperatively for symptoms of ischemia. By means of Cox proportional hazard models, the relationships between anastomotic patency and target vessel location, proximal stenosis, target diameter, and quality were assessed.
Results:
A total of 231 radial artery anastomoses were evaluated. The mean stenosis for patent anastomoses was 82% compared with 71% for occluded anastomoses (P <.001). Anastomotic patency for targets with moderate stenosis (< or = 70%) was worse than that for vessels with critical stenosis (> or = 90%; relative risk, 1.7; 95% confidence interval, 1.3-2.2; P <.001). Patency for targets of the right coronary artery was statistically inferior to that for targets of the left anterior descending artery (relative risk, 1.8; 95% confidence interval, 1.2-2.9; P =.01) and bordered on significance versus that for the circumflex artery distribution (relative risk, 1.6; 95% confidence interval, 1.0-2.8; P =.06). When directed toward critically stenosed targets of the left anterior descending or circumflex arteries, radial artery patency was not statistically different that that of the internal thoracic artery (P =.19).
Conclusion:
Radial artery patency is sensitive to both target location and proximal target stenosis. Selective use of the radial artery to targets of the left anterior descending and circumflex distributions remains encouraging. Radial artery grafts to targets of the right coronary artery or those with moderate stenosis appear to be at particularly high risk of failure.
