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
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Radial ArteryAdvantages
• Relative large size• Few wound complications• Easy to work with• Prepare simultaneously with ITA• Long
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Radial Artery Disadvantages
• Sclerosis in diabetics• Damage by radial arterial lines• Ulnar flow may be insufficient• ? Patency
- Coronary Artery
- Competitive Flow
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Study
Patients 190Intervention Radial artery graftingSetting Single center Time period 1996 to 2002F/U 6 yearsEndpoint Angiographic graft
patency
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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
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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
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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
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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%
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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
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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
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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)
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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)
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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