J Thorac Cardiovasc Surg 2005;130:7-8
© 2005 The American Association for Thoracic Surgery
Division of Cardiothoracic Surgery, Washington University School of Medicine and Forest Park Hospital, St Louis, Mo.
Received for publication March 4, 2005; accepted for publication March 14, 2005. * Address for reprints: Hendrick B. Barner, MD, 6125 Clayton Ave, Ste 430, St Louis, MO 63139. (Email: Hendrick.Barner@forestparkhospital.com).
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Accumulating experience with the radial artery as a coronary bypass conduit has revealed limitations and some advantages. A report in this issue of the Journal is a flag that suggests a late potential complication of radial artery harvest, namely accelerated arteriosclerosis caused by hemodynamic stress in the remaining ulnar artery. 1
To better understand this issue, it is important to examine the available information about the aging of small- and medium-sized arteries in an environment of risk factors for arterial disease, including altered flow. In the 1970s, some predicted that the internal thoracic artery (ITA) would develop accelerated arteriosclerosis because of the stressful nature of the coronary circulation, when in fact this was true of the saphenous vein.
Because not much data are available on the ulnar artery, it is necessary to extrapolate observations from other arteries to the ulnar artery, particularly from the radial artery, which is similar with regard to size, vascular bed, microanatomy, and location in the arterial tree.
Native ulnar artery flow varies with its size and that of its counterpart, the radial artery. Overall, in situ flow was 46% greater in the radial artery, but flow was similar in 26.5%, greater in 56.9%, and less in 16.6% in 211 nondominant arms assessed for hemodialysis access. 2
Microscopic assessment of the distal radial artery revealed intimal hyperplasia (type B arteriosclerosis) in 94% and 69% of ITAs (n = 110
J. Thorac. Cardiovasc. Surg. 2005 130: 7-8.
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