The Use of Radial Artery for CABG: An Update

Abstract

We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.

Prevalence of The Arterial Hand Dominance Using the Modified Allen Test and Pulse Oximetry among Plastic Surgery Patients

“…Although the proportion of individuals who are at risk for significant ischemia may be minor, tissue loss in these situations is a significant casualty. [9][10][11][12] The accepted dogma of ulnar predominance is evidently based on historical findings that have yet to be reassessed in modern clinical practice despite its critical implications. Having a misguided preconception of such epidemiological data may influence the subsequent interpretation of the determination of arterial dominance.…”

“…Although the proportion of individuals who are at risk for significant ischemia may be minor, tissue loss in these situations is a significant casualty. 9–12…”

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

“…Third, once recanalized, the artery’s long-term patency rate is high (90%). Nevertheless, the artery should not be used by surgeons as bypass conduit for coronary revascularization or as radial artery–cephalic vein arteriovenous fistula for patients on chronic hemodialysis, both being risky options without any supporting evidence [ 32 , 33 ].…”

Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery

“…Alternatively, patients undergoing BIMA are at a higher risk of sternal wound infection, which would make RA a safer option during preoperative planning [ 56 ]. Surgeons have reported other technical advantages in the use of RA, including reduced operation time since it can be harvested at the same time as LIMA, adaptable length to reach distal targets, and easy handling due to thick muscular layer [ 57 , 58 ].…”