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The radial artery as a conduit for coronary artery bypass grafting

1999; BMJ; Volume: 82; Issue: 4 Linguagem: Inglês

10.1136/hrt.82.4.409

1468-201X

David P. Taggart,

Aortic Disease and Treatment Approaches

Over the past five years several groups have promoted the use of the radial artery as the second conduit of choice for coronary artery bypass grafting (CABG), after the left internal mammary artery (LIMA) and in preference to the saphenous vein. The attractions of the radial artery to the surgeon are immediate and obvious: it is a versatile conduit that can be harvested easily and safely, it has handling characteristics superior to those of other arterial grafts, and it reaches comfortably any coronary target.1 For the patient it offers the long term prospect of superior patency compared to vein grafts2 3 and the immediate benefit of avoiding the frequently underestimated morbidity of leg wounds.4 Ten years after CABG, 90% of LIMA grafts are patent and disease free while 75% of vein grafts are occluded or severely stenosed.5 As well as establishing the LIMA as the conduit of first choice for CABG this has promoted the use of other arterial conduits including the right IMA, the gastroepiploic, and the inferior epigastric artery. Despite evidence of clinical and survival benefits of using more than one arterial graft5 the absence of any large randomised trials with long term follow up, allied to the increased technical demands of using multiple arterial grafts, has precluded widespread use. A similar position existed over the use of a single IMA graft before the seminal article from the Cleveland clinic in 1986,6 but the user friendliness of the radial artery may be changing this perspective. Carpentier and colleagues first proposed the use of the radial artery for CABG in 1973,7 but within a few years reports of spasm and occlusion led to its abandonment. In 1989, and inspired by several angiographically patent radial artery grafts up to 18 years …