RADIAL ARTERY AND INFERIOR EPIGASTRIC ARTERY IN COMPOSITE GRAFTS - IMPROVED MIDTERM ANGIOGRAPHIC RESULTS

Background. The improving results with use of the radial artery and th e inferior epigastric artery as coronary bypass conduits were analyzed to assess the suitability of these arteries for myocardial revascular ization. Methods. Both arteries were used in composite arterial condui ts with an internal mammary artery as the blood source. The proximal a nastomosis was always constructed before the initiation of cardiopulmo nary bypass. From October 1991 to January 1995, 240 patients underwent myocardial revascularization using 163 radial arteries and 124 inferi or epigastric arteries with one (224 instances) or both (two instances ) internal mammary arteries as inflow conduits. Twenty-five saphenous veins were concomitantly used. There were 208 men and 32 women with a mean age of 60.8 +/- 8.6 years (range, 28 to 80 years). In 73 patients (30.4%), the operation was performed on an urgent basis, and in 11 (4 .6%), it was a repeat operation. The mean left ventricular ejection fr action was 0.55 +/- 0.12, and in 21 patients (8.8%), it was less than 0.35. Of 681 distal anastomoses, 188 were constructed using the radial artery (35 double and one triple sequential anastomosis) and 125, usi ng the inferior epigastric artery (one double sequential anastomosis). A mean of 3.0 arterial anastomoses per patient were constructed (3.1 anastomoses/patient including saphenous veins). Six patients (2.5%) un derwent associated procedures: aortic valve replacement (2), carotid e ndarterectomy (2), mitral valve replacement (1), and aortic valve and ascending aorta replacement (1). Most of the inferior epigastric arter ies were grafted on diagonal branches and most of the radial arteries, the circumflex territory. Results. No deaths occurred in the operatin g room. Three patients (1.3%) died postoperatively, and 2 patients (0. 8%) died 6 months after operation. At a mean follow-up of 18.5 +/- 10. 4 months (range, 1 to 39 months), 227 patients (96.6%) were asymptomat ic. The cumulative patency rate of the radial artery grafts was 93.1% and of the inferior epigastric artery grafts, 95.7%. Conclusions. Our data suggest that use of the RA and the IEA in composite conduits for myocardial revascularization is feasible. These arteries can be safely used when bilateral internal mammary artery or sequential internal ma mmary artery grafting is not advisable.