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J Thorac Cardiovasc Surg 1998;116:981-989
© 1998 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

THE RADIAL ARTERY FOR CORONARY ARTERY BYPASS GRAFTING: CLINICAL AND ANGIOGRAPHIC RESULTS AT FIVE YEARS

From the Department of Cardiovascular Surgery, Hôpital Bichat and Hôpital Broussais, Paris.

Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 4-7, 1997.

Received for publication May 6, 1998. Revisions requested June 17, 1998; revisions Received July 14, 1998. Accepted for publication Aug 6, 1998. Address for reprints: Christophe Acar, MD, Chirurgie Cardiovasculaire, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France.

Objective: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting.
Methods: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 ± 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 ± 1.40 years).
Results: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery.
Conclusion: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.

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				M. W. Connolly, L. D. Torrillo, M. J. Stauder, N. U. Patel, J. C. McCabe, D. F. Loulmet, and V. A. Subramanian Endoscopic radial artery harvesting: results of first 300 patients Ann. Thorac. Surg., August 1, 2002; 74(2): 502 - 506. [Abstract] [Full Text] [PDF]

				K. Nakamura, S. Al-Ruzzeh, A. H. Chester, I. Schmidt, M. Barbir, M. H. Yacoub, and M. Amrani Effects of cerivastatin on vascular function of human radial and left internal thoracic arteries Ann. Thorac. Surg., June 1, 2002; 73(6): 1860 - 1865. [Abstract] [Full Text] [PDF]

				A. Amano, A. Takahashi, and H. Hirose Skeletonized radial artery grafting: improved angiographic results Ann. Thorac. Surg., June 1, 2002; 73(6): 1880 - 1887. [Abstract] [Full Text] [PDF]

				H. Hirose, A. Amano, and A. Takahashi On-Pump Versus Off-Pump Coronary Artery Bypass Using Quadruple Arterial Grafts Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 101 - 106. [Abstract] [Full Text] [PDF]

				G.G. Santos, N.A.G. Stolf, L.F.P. Moreira, V.L.S. Haddad, R.M.C. Simoes, S.R.V. Carvalho, A.A. Salgado, and S.F. Avelar Jr. Randomized comparative study of radial artery and right gastroepiploic artery in composite arterial graft for CABG Eur. J. Cardiothorac. Surg., June 1, 2002; 21(6): 1009 - 1014. [Abstract] [Full Text] [PDF]

				M. Ikeda, H. Ohashi, Y. Tsutsumi, K. Hige, T. Kawai, and M. Ohnaka Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 800 - 803. [Abstract] [Full Text] [PDF]

				V. S. Reddy, S. M. Parikh, D. C. Drinkwater Jr, A. Lo, T. P. Rauth, R. M. Moleski, and P. A. Chang Morbidity after procurement of radial arteries in diabetic patients and the elderly undergoing coronary revascularization Ann. Thorac. Surg., March 1, 2002; 73(3): 803 - 808. [Abstract] [Full Text] [PDF]

				Z. S. Meharwal and N. Trehan Routine Use of the Radial Artery for Coronary Artery Revascularization Asian Cardiovasc Thorac Ann, March 1, 2002; 10(1): 20 - 24. [Abstract] [Full Text] [PDF]

				J. B. Christensen, J. T. Lund, E. Kassis, and H. Kelbaek Complete arterial coronary revascularisation using radial artery conduit for double thoracic artery inlet flow: arterial sling operation Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 391 - 394. [Abstract] [Full Text] [PDF]

				N. Roberts, S. Ghosh, M. Boehm, and M. Galinanes The radial hyperaemic response: a new and objective assessment of ulnar collateral supply to the hand Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 549 - 552. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. D. Mauro, S. D'Alessandro, G. Teodori, G. Vitolla, M. Contini, A. L. Iaco, and G. Spira Revascularization of the lateral wall: Long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 225 - 231. [Abstract] [Full Text] [PDF]

				J. Tatoulis, A. G. Royse, B. F. Buxton, J. A. Fuller, P. D. Skillington, J. C. Goldblatt, R. P. Brown, and M. A. Rowland The radial artery in coronary surgery: a 5-year experience--clinical and angiographic results Ann. Thorac. Surg., January 1, 2002; 73(1): 143 - 148. [Abstract] [Full Text] [PDF]

				A.S. Coonar and J.R. Pepper Vasodilator pre-treatment of human radial arteries Eur. Heart J., December 1, 2001; 22(23): 2146 - 2147. [PDF]

				I. Saeed, A. C. Anyanwu, M. H. Yacoub, and M. Amrani Subjective patient outcomes following coronary artery bypass using the radial artery: results of a cross-sectional survey of harvest site complications and quality of life Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1142 - 1146. [Abstract] [Full Text] [PDF]

				S. V. Moran, R. Baeza, E. Guarda, R. Zalaquett, M. J. Irarrazaval, E. Marchant, and C. Deck Predictors of radial artery patency for coronary bypass operations Ann. Thorac. Surg., November 1, 2001; 72(5): 1552 - 1556. [Abstract] [Full Text] [PDF]

				Z. S. Meharwal and N. Trehan Functional status of the hand after radial artery harvesting: results in 3,977 cases Ann. Thorac. Surg., November 1, 2001; 72(5): 1557 - 1561. [Abstract] [Full Text] [PDF]

				G.-W. He and Z.-G. Liu Comparison of Nitric Oxide Release and Endothelium-Derived Hyperpolarizing Factor-Mediated Hyperpolarization Between Human Radial and Internal Mammary Arteries Circulation, September 18, 2001; 104 (2009): I-344 - I-349. [Abstract] [Full Text] [PDF]

				A. L. Iaco, G. Teodori, G. Di Giammarco, M. Di Mauro, L. Storto, V. Mazzei, G. Vitolla, B. Mostafa, and A. M. Calafiore Radial artery for myocardial revascularization: long-term clinical and angiographic results Ann. Thorac. Surg., August 1, 2001; 72(2): 464 - 468. [Abstract] [Full Text] [PDF]

				J. Chanda and C. C. Canver Reversal of preexisting vasospasm in coronary artery conduits Ann. Thorac. Surg., August 1, 2001; 72(2): 476 - 480. [Abstract] [Full Text] [PDF]

				O. Wendler, P. Landwehr, D. Bandner-Risch, T. Georg, and H.-J. Schafers Vasoreactivity of arterial grafts in the patient with diabetes mellitus: investigations on internal thoracic artery and radial artery conduits Eur. J. Cardiothorac. Surg., August 1, 2001; 20(2): 305 - 311. [Abstract] [Full Text] [PDF]

				R. Dion, D. Glineur, D. Derouck, R. Verhelst, P. Noirhomme, G. El Khoury, E. Degrave, and C. Hanet Complementary saphenous grafting: Long-term follow-up J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 296 - 304. [Abstract] [Full Text] [PDF]

				P. Ruengsakulrach, M. Brooks, R. Sinclair, D. Hare, I. Gordon, and B. Buxton Prevalence and prediction of calcification and plaques in radial artery grafts by ultrasound J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 398 - 399. [Full Text] [PDF]

				C.V Patil, E Nikolsky, M Boulos, E Grenadier, and R Beyar Multivessel coronary artery disease: current revascularization strategies Eur. Heart J., July 2, 2001; 22(14): 1183 - 1197. [PDF]

				A. Amano, H. Hirose, A. Takahashi, and N. Nagano Coronary artery bypass grafting using the radial artery: midterm results in a Japanese institute Ann. Thorac. Surg., July 1, 2001; 72(1): 120 - 125. [Abstract] [Full Text] [PDF]

				M. Lemma, G. Gelpi, A. Mangini, P. Vanelli, C. Carro, A. Condemi, and C. Antona Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery Ann. Thorac. Surg., June 1, 2001; 71(6): 1969 - 1973. [Abstract] [Full Text] [PDF]

				T. A. Denton, L. Trento, M. Cohen, R. M. Kass, C. Blanche, S. Raissi, W. Cheng, G. P. Fontana, and A. Trento Radial artery harvesting for coronary bypass operations: Neurologic complications and their potential mechanisms J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 951 - 956. [Abstract] [Full Text] [PDF]