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Use of the radial artery for myocardial revascularization
1Cardiac Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
The radial artery shows promising early patency for coronary artery bypass grafting. Careful surgical technique is crucial for optimal graft function in myocardial revascularization procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Myocardial Revascularization
Background:
- The radial artery was initially used for coronary grafting in 1973 but was abandoned due to poor outcomes.
- Its use was revived in 1992, coinciding with the adoption of calcium-channel blockers to mitigate vasospasm during cardiovascular surgery.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using the radial artery as a coronary graft.
- To compare two distinct surgical techniques for radial artery graft preparation and anastomosis.
Main Methods:
- 109 patients underwent myocardial revascularization using the radial artery between January 1993 and October 1995.
- Group 1 (95 patients) received a pretreated radial artery graft (fascia opened, hydrostatic dilation) anastomosed to the aorta.
- Group 2 (14 patients) had the radial artery branched to another conduit.
Main Results:
- Two operative deaths (1.82%) occurred among 109 patients.
- At a mean follow-up of 532 days, 105 patients were alive.
- Angiography in 56 patients revealed radial artery patency rates of 88.88% in group 1 and 62.50% in group 2.
Conclusions:
- The radial artery is a manageable conduit for coronary artery bypass grafting.
- Early patency results are encouraging, suggesting potential for myocardial revascularization.
- Long-term follow-up is necessary to fully ascertain the durability of radial artery grafts.
Background:
The radial artery was first used as a coronary graft by Carpentier and associates in 1973 but, due to the disappointing results, it was abandoned. In 1992 its revival coincided with the widespread use of calcium-channel blockers in cardiovascular surgery, in the belief they could prevent spasm.
Methods:
From January 1993 to October 1995 we operated on 109 patients for myocardial revascularization employing the radial artery with two different surgical techniques: in 95 patients (group 1) it was "pretreated" by opening its fascia after a gentle hydrostatic dilation and then anastomosed to the aorta; in 14 patients (group 2) it was branched to another conduit. We had two operative deaths (1.82%).
Results:
At a mean interval of 532.42 days 105 patients are still alive, 2 (1.86%) having died of abdominal tumors. Fifty-six patients (52.33%) underwent angiography at a mean interval of 334.42 days: the patency of the radial artery was 88.88% in group 1 and 62.50% in group 2. Indications and contraindications are discussed.
Conclusions:
The radial artery is an easily manageable conduit whose early patency is very promising, although a longer follow-up is mandatory.