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Never again. Once used for cardiac catherization the radial artery cannot be used for CABG
David Chadow1, Giovanni J Soletti1, Mario Gaudino1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Insights
Transradial access (TRA) for cardiac catheterization may cause long-term radial artery (RA) damage, making it unsuitable for coronary artery bypass grafting (CABG). This study suggests prior TRA is a contraindication for RA use in CABG due to irreversible structural changes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Radial artery (RA) use in coronary artery bypass grafting (CABG) is increasing, potentially becoming the standard for multivessel coronary artery disease.
- Transradial access (TRA) is the preferred method for cardiac catheterization due to fewer complications compared to the femoral approach.
Purpose of the Study:
- To investigate the long-term structural integrity of the radial artery (RA) after prior transradial access (TRA) for coronary angiography.
- To determine if TRA compromises the suitability of the RA as a conduit for coronary artery bypass grafting (CABG).
Main Methods:
- Histopathological examination of radial arteries from two patients who underwent TRA 8 and 12 years prior.
- Assessment of vascular wall structure, lumen patency, and signs of chronic injury.
Main Results:
- Both patients exhibited chronic injury to the radial artery, including dissection and lumen obstruction.
- Fibrosis was identified as the cause of lumen obstruction, indicating irreversible damage.
Conclusions:
- Prior transradial access (TRA) can lead to long-term, irreversible structural damage to the radial artery (RA).
- This damage renders the RA unsuitable for use as a conduit in coronary artery bypass grafting (CABG).
- Transradial access should be considered a contraindication for subsequent radial artery harvesting for CABG.
Abstract:
The use of the radial artery (RA) as a conduit in coronary artery bypass grafting (CABG) has been steadily increasing since the early 1990s and based on the most recent data may well become the standard of care for patients with multivessel coronary artery disease requiring multiple arterial grafts. The transradial access (TRA) approach for cardiac catherization has also increased steadily in use by interventional cardiologists owing to its reduction in bleeding and vascular complications when compared with the femoral approach and is now considered the preferred arterial access. However, prior use of TRA for cardiac catherization is a contraindication for the use of the RA for CABG because of high rates of structural damage to the vascular wall and potential for graft failure. In this issue of the Journal of Cardiac Surgery Clarke et al. examine the RA of two patients who had TRA for coronary angiography 8 and 12 years prior and note that both patients had chronic injury with dissection and obstruction of the lumen secondary to fibrosis suggesting that TRA causes long-term and irreversible damage rendering them unsuitable as conduits for CABG.
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