Radial artery graft has good long-term patency in coronary surgery
medwireNews: The long-term patency of radial artery (RA) grafts is nearly on a par with that of left internal thoracic artery (ITA) grafts and better than that of saphenous vein (SV) grafts, shows a 20-year study.
Mario Gaudino (Weill Cornell Medical College, New York, USA) and co-researchers followed up all of the first 100 patients in whom they used an RA graft. The RA was usually grafted to the second target vessel, most often a branch of the circumflex artery or the right coronary artery, with the left ITA usually used for the left anterior descending artery.
Thirty-three of the 36 patients who survived for 20 years were assessed for graft patency, revealing RA graft patency and perfect patency rates of 84.8% and 72.7%, respectively. This was lower than the corresponding rates for the left ITA, of 93.9% and 93.9%, but not significantly so.
And the rates for the RA were markedly better than the SV patency and perfect patency rates, of 45.1% and 25.8%, the researchers report in the Journal of the American College of Cardiology.
Most patients who did not survive the whole 20-year follow-up survived the first decade, with just two cardiac and four noncardiac deaths during this period. During the second decade, 21 patients died of cardiac causes, predominantly heart failure, and 37 died of noncardiac causes.
All but two patients were assessed for graft patency at least once during follow-up; the cumulative rates of graft occlusion were 19% for the left ITA, 25% for the RA and 55% for the SV.
Of note, no patient had any symptoms of hand ischaemia during follow-up, and among 25 who underwent echo Doppler assessment of the forearm, the only difference between the operated and non-operated arms was a significant increase in the diameter of the ulnar artery.
In a linked editorial, Marc Ruel (University of Ottawa, Ontario, Canada) and Pierre Voisine (Québec Heart and Lung Institute, Canada) say: “Although the RA does not perform as well as the ITA, it is close, and is much better than an SV, which confirms what many presumed, but not all believed.”
They add: “The next big question is: does the use of the RA, rather than a vein, decrease major adverse cardiovascular and cerebrovascular events and mortality, and is it as good as the bilateral ITAs?”
“Unfortunately, despite the quality of the present paper, both dilemmas still cannot be answered with a high level of evidence.”
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