radial artery grafting when to do it ( when to not do it ) joseph f. sabik, md chairman and...
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Radial Artery Grafting When to do it
( when to not do it )
Joseph F. Sabik, MDChairman and Professor of Surgery
Department of Thoracic and Cardiovascular Surgery
Sheik Hamdam Bin Rashid Al Maktoum Distinguished Chair
Cleveland Clinic Lerner College of Medicine
Radial ArteryAdvantages
• Relative large size• Few wound complications• Easy to work with• Prepare simultaneously with ITA• Long
Radial Artery Disadvantages
• Sclerosis in diabetics• Damage by radial arterial lines• Ulnar flow may be insufficient• ? Patency
- Coronary Artery
- Competitive Flow
Study
Patients 190Intervention Radial artery graftingSetting Single center Time period 1996 to 2002F/U 6 yearsEndpoint Angiographic graft
patency
100
90
80
70
60
500 12 24 36 72
Months after CABG
%
Zacharias, et. al., Circ, 2004
Graft PatencyITA, Radial, SVG
Vein (588)
Radial (242)
LITA (398)
48 60
Study
Patients 109Intervention Radial artery grafting
Composite “T” graft from ITA
Setting Single center Time period 1993 to 2001Mean F/U 27.1 monthsEndpoint Angiographic patency
Radial Artery Patency Coronary Artery
100
80
60
40
20
00 12 24 36 48
Time (months)
RCA
LAD
Cx
%
Maniar et al: JTCS 2002
Radial Artery PatencyProximal Coronary Stenosis
100
80
60
40
20
00 12 24 36 48
Time (months)
<70%
90-100%
%
Maniar et al: JTCS 2002
71-89%
Study
Patients 68 Intervention Radial artery grafting
Aortic proximalSetting Single center Time period 1993 to 1998Mean F/U 59 +/- 6.5 mthsEndpoint 5 year angiographic
patency
Radial Grafts PatencyTarget-Vessel Stenosis
Occluded
String
Patient with irregularities
Perfectly patent
100
80
60
40
20
0
RAGrafts
(%)
50-60 70-80 80-90 >90
Target vessels stenosis (%)Possati et al: JTCS 1998
Radial Artery Patency Critically Stenosed Left Coronaries
100
80
60
40
20
00 12 24 36 48
Time (months)
p=0.19
ITA (n=144)
%
Maniar et al: JTCS 2002
RA (n=43)
Radial Artery Patency Moderately Stenosed RCA
100
80
60
40
20
00 12 24 36 48
Time (months)
p<0.001
ITA (n=144)
%
Maniar et al: JTCS 2002
RA (n=30)
Summary
• Target Vessel and Target vessel stenosis (competitive flow) important predictors of radial artery patency
• Best when used to graft severely stenotic left sided coronary arteries
• Worst when used to graft moderately stenosed right sided coronary arteries