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J Thorac Cardiovasc Surg 2005;129:250-253
© 2005 The American Association for Thoracic Surgery

Editorials

Radial artery conduits for coronary artery bypass grafting: Current perspective

Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom

Received for publication June 27, 2004; revisions received July 23, 2004; accepted for publication July 28, 2004.

^* Address for reprints: David P. Taggart, MD(Hons), PhD, FRCS, Professor of Cardiovascular Surgery, University of Oxford, and Consultant Cardiothoracic Surgeon, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK (E-mail: david.taggart@orh.nhs.uk).

The first 300 words of the full text of this article appear below.

Total arterial revascularization offers the potential to avoid the problems associated with vein graft failure. Bilateral internal thoracic arteries (ITAs) are the conduits of first choice because of excellent short- and long-term patency and the possibility of improved survival.¹ The radial artery (RA) is easily harvested, versatile, has excellent handling characteristics, and has become the arterial conduit of third choice.² Issues remain concerning its optimal use, however, particularly with reference to preoperative assessment, harvesting techniques, vasospasm prophylaxis, grafting strategy, and long-term patency. This article critically examines the current evidence for these important aspects of RA use.

	Preoperative assessment

 
Preoperative assessment of the RA and collateral hand circulation is mandatory to avoid hand ischemia in patients with an inadequate collateral circulation. The most widely used clinical test for assessment of adequate collateral circulation to the hand is the modified Allen test. In our own practice, 85% of patients have the RA safely harvested after clinical assessment only.³ In the remaining 15% with equivocal or positive Allen tests, further imaging is performed with duplex ultrasonography, which combines pulsed Doppler with a B-mode imager to record vessel flow velocity, vessel caliber and anatomic variations, and severity of atherosclerotic lesions along the entire length of the vessel. Use of bilateral forearm duplex scanning when clinical assessment is equivocal has enabled the use of RA conduits in 99% of patients scheduled for total arterial coronary artery bypass grafting (CABG).³

Concern about the reliability of the Allen test has prompted evaluation of other assessment techniques, such as digital pulse oximetry, digital plethysmography, and Doppler ultrasonographic methods. However, there is no convincing evidence that these result in improved clinical outcomes after RA harvest.

	Harvesting technique

 
Improved harvesting techniques are fundamental to the current success of radial grafts in CABG. Further refinements may result in improvements to graft function, reduced complications, and . . . [Full Text of this Article]