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Twelve years' experience and clinical results of using the radial artery for coronary revascularization
Zhaoyun Cheng1, Ziniu Zhao2, Xiaoqiang Quan2
1Zhengzhou University School of Basic Medicine, Zhengzhou, Henan 450052, China.
Insights
The radial artery (RA) is an excellent conduit for coronary artery bypass grafting (CABG), demonstrating 93.1% long-term patency. Careful harvesting and selection of target vessels ensure good graft success in arterial revascularization.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Cardiac Surgery
Background:
- The radial artery (RA) is increasingly utilized as a conduit in coronary artery bypass grafting (CABG).
- Long-term outcome data for RA use in CABG remains limited.
- This study reports findings from a 12-year period using RA for CABG.
Purpose of the Study:
- To evaluate the long-term clinical, angiographic, and intravascular ultrasound results of using the radial artery as a conduit in CABG.
- To assess the patency rates and identify factors influencing outcomes.
Main Methods:
- A total of 118 radial artery conduits were harvested from 93 patients (87 males, 6 females) between 2001 and 2013.
- An "intra-operative Allen's test" and "double-clip & scissors-cut" technique were employed during harvesting.
- 122 out of 272 distal anastomoses (44.9%) were constructed using radial arteries.
Main Results:
- Follow-up at a mean of 59 months revealed a 93.1% patency rate for radial artery conduits.
- Internal mammary artery patency was 96.4%.
- One case of "string sign" was observed in a patient with a specific coronary artery anatomy.
Conclusions:
- The radial artery serves as an excellent conduit, expanding options for total arterial CABG.
- Careful surgical techniques and appropriate selection of target coronary arteries are crucial for achieving high graft patency.
Background:
The radial artery (RA) is becoming a popular conduit for coronary artery bypass grafting (CABG), yet data reporting the long-term results are rare. We reported our clinical, angiographic and intravascular ultrasound findings on 93 patients who had the RA used as part of the conduit for the CABG procedures during a 12-year period from June 2001 to June 2013.
Methods:
A total of 118 radial artery conduits were harvested in 87 males and 6 females, age from 28 to 66 (mean 49.9) years. An "intra-operative Allen's test" was developed to safeguard blood supply to the arm and hand. A "double-clip & scissors-cut" technique was carried out to minimize the thermal injury to the radial artery from the diathermy. The left radial artery was used in 67 patients, the right in one, and bilateral radial arteries in 25 patients. One hundred and twenty-two out of 272 distal anastomoses (44.9%) were constructed with radial arteries, with an average of 2.9 grafts per patient (range 2-6).
Results:
Follow-up angiography and intravascular ultrasound study at 3-139 postoperative months (mean 59 months) revealed a 93.1% RA patency. String sign occurred in one patient in whom the RA was directed to a big right coronary artery with a stenosis of around 50%. The patency for the internal mammary artery was 96.4%.
Conclusions:
The RA is an excellent conduit that broadens the options for total arterial CABG surgery. Good graft patency could be achieved through careful harvesting techniques and choice of proper target coronary vessels.
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