Original article
Adult cardiac
Long-Term Patency of 1108 Radial Arterial-Coronary Angiograms Over 10 Years

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
https://doi.org/10.1016/j.athoracsur.2009.03.086Get rights and content

Background

To avoid late vein graft atheroma and failure, we have used arterial grafts extensively in coronary operations. The radial artery (RA) is the conduit of second choice. This study determined the long-term patency of the RA as a coronary graft.

Methods

Two independent observers evaluated 1108 consecutive postoperative RA conduit angiograms performed between January 1997 and June 2007 for cardiac symptoms. Mean time to postoperative angiography was 48.3 months (range, 1 to 132 months). An RA graft was considered failed (nonpatent) if there was stenosis exceeding 60%, string sign, or occlusion. Patency was determined over time, by coronary territory grafted and by the degree of native coronary artery stenosis (NCAS).

Results

At a mean of 48.3 months, 982 of the 1108 RA grafts (89%) were patent. RA patencies for the left anterior descending were 96% (24 of 25), diagonal/intermediate, 90% (121 of 135); circumflex marginal, 89% (499 of 561); right coronary, 83% (38 of 46); posterior descending, 89% (253 of 286); and left ventricular branch/posterolateral, 86% (47 of 55). Patency was 87.5% (56 of 64) for NCAS of less than 60% compared with 89% (926 of 1044; p = 0.89) for NCAS exceeding 60%. Of 318 RAs in place more than 5 years, 294 (92.5%) were patent, and for 107 RAs in place for more than 7 years, 99 were patent (92.5%). Patency was consistent through each year of the decade. Mechanisms of failure did not involve development of atherosclerosis. Patent RA grafts were smooth, with no angiographic evidence of atheroma.

Conclusions

Late patencies of RA grafts are excellent and justify continuing use of the RA in coronary operations.

Section snippets

Material and Methods

Institutional ethics approval was obtained to collect postoperative angiographic coronary conduit data (CREC Project 1997.004). Individual specific patient consent for postoperative coronary graft angiography was also obtained in every instance.

We studied 1108 consecutive postoperative RA conduit angiograms performed between January 1997 and June 2007 for possible postoperative cardiac symptoms. Symptoms included typical angina, atypical chest pain, new myocardial infarction, and unexplained

Overall RA Conduit Patency

Angiograms for 1108 RA conduits were studied. The mean interval from the initial operation to the postoperative RA angiogram was 48.3 ± 40 months (range 1 to 132 months). At 48 months postoperatively, 982 of the 1108 RA grafts had perfect patency (89%) and 126 grafts failed (stenosis ≥ 60%, string sign, total occlusion).

RA Conduit Patency: Influence of Territory Grafted

RA graft patency was best when the RA was grafted to the LAD (96%) and worst when grafted to the main right coronary artery (RCA) usually between the acute margin and the crux

Comment

It has been 15 years since the reintroduction of the RA as an additional arterial conduit to the LITA (and RITA), to circumvent the failure of SVG from intimal hyperplasia and atherosclerosis—especially in the 5- to 15-year time frame. Even in contemporary randomized trials, SVG patencies are lower than for arterial grafts [17, 18, 19]. Although the RA has been used with increasing frequency in CABG since 1993 with many reports and reviews on its use, RA patency reports have been mainly

References (29)

  • H.S. Maniar et al.

    Effect of target stenosis and location or radial artery graft patency

    J Thorac Cardiovasc Surg

    (2002)
  • A.M. Calafiore et al.

    Revascularization of the lateral wall: long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting

    J Thorac Cardiovasc Surg

    (2002)
  • G.L. Grunkemeier et al.

    Actual versus actuarial event-free percentages

    Ann Thorac Surg

    (2001)
  • F.D. Loop et al.

    Influence of the internal mammary-artery graft on 10-year survival and other cardiac events

    N Eng J Med

    (1986)
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