Radial artery in CABG: Could the early results be comparable to internal mammary artery graft?

Background. The accidental detection of patency of radial artery grafts, by Acar, which had been labeled as blocked 18 years earlier, has led to its r evival as a conduit in coronary artery bypass surgery. We used radial arter y as one of the grafts in 287 patients from February 1996 to June 1998. Her e we present our early clinical experience and the midterm angiographic fol low up of the initial 62 patients. Methods. A no touch, atraumatic harvesting technique coupled with gentle hy drostatic and pharmacological dilatation of the radial artery graft was emp loyed. Radial artery was used to revascularize coronary vessels with >80% p roximal stenosis. Postoperatively, the patients were administered a low dos e nifedipine that was continued for 6 months thereafter. The patients were followed up clinically after discharge from the hospital and angiographic e valuation of the grafted radial artery by selective injection was done at a mean interval of 16.2 +/- 5.1 months (3-24 months) postoperatively. Results. There was no perioperative or late myocardial infarction or mortal ity. No significant complications related to the harvesting of radial arter y were encountered. Angiographically, the radial artery grafts were found t o be patent in 96.8% of patients (60/62). Mild distal anastomotic narrowing was seen in angiogram of one patient with good filling of the target vesse l. Another patient showed diffuse spasm of radial artery graft. The patency of the pedicled left internal mammary grafts was also 98.2% (56/57). All t he patients were asymptomatic. Conclusions. Radial artery seems to be an excellent alternate arterial cond uit for myocardial revascularization with early and midterm patency rates e quivalent to that of pedicled internal mammary artery, and it should be use d more often for myocardial revascularization as an adjunct to pedicled int ernal mammary artery graft. (C) 1999 by The Society of Thoracic Surgeons.