Venous reconstruction with radial artery harvesting: Domino method

We describe two cases of venous reconstruction after radial artery (RA) harvesting for coronary artery bypass grafting (CABG). Patient 1, a 70-year-old man who underwent CABG 16 years earlier, presented with acute posterolateral myocardial infarction caused by total occlusion of the saphenous vein graft (SVG). RA grafting was considered ideal, but he had bilateral hypoplastic ulnar arteries. Venous reconstruction with RA harvesting using SVG was performed, and surgery was successful. Patient 2, a 57-year-old-man with chronic renal failure caused by polycystic kidney disease, presented with angina pectoris. Off-pump CABG was recommended. We used a right internal thoracic artery and the RA as an I-composite graft. However, RA preservation was essential for future hemodialysis. The RA was harvested and reconstructed as described for patient 1. Ischemia had not developed in the hands and forearms as of 5 years after the surgery. We believe that the method may be an alternative graft choice in CABG.