Radial artery and inferior epigastric artery in composite grafts: improved midterm angiographic results.
BACKGROUND
The improving results with use of the radial artery and the inferior epigastric artery as coronary bypass conduits were analyzed to assess the suitability of these arteries for myocardial revascularization.


METHODS
Both arteries were used in composite arterial conduits with an internal mammary artery as the blood source. The proximal anastomosis was always constructed before the initiation of cardiopulmonary bypass. From October 1991 to January 1995, 240 patients underwent myocardial revascularization using 163 radial arteries and 124 inferior 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 fraction 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, using 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%) underwent associated procedures: aortic valve replacement (2), carotid endarterectomy (2), mitral valve replacement (1), and aortic valve and ascending aorta replacement (1). Most of the inferior epigastric arteries were grafted on diagonal branches and most of the radial arteries, the circumflex territory.


RESULTS
No deaths occurred in the operating 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 asymptomatic. 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 mammary artery grafting is not advisable.
Calafiore
A M
AM
Cattedra di Cardiochirurgia, Università di Chieti, Italy.
Di Giammarco
G
G
Teodori
G
G
D'Annunzio
E
E
Vitolla
G
G
Fino
C
C
Maddestra
N
N
D000009:Abdominal Muscles / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001158:Arteries / Q000637:transplantation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left