Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency.
OBJECTIVE
The radial artery graft (RA) still involves two unsolved problems, namely, vasospasm and intimal hyperplasia, although satisfactory early and mid-term outcomes have been obtained recently.


METHODS
Two hundred patients underwent coronary artery bypass surgery with RA between October,1996 and December,2000. We made a comparison of the luminal diameters at early and mid-term periods in 23 patients who underwent mid-term angiographies after a mean follow-up of 27 months. The proximal anastomoses of the RA were the ascending aorta in these patients. The G/N ratio was determined as a ratio of the luminal diameter of the graft to that of the revascularized coronary artery so as to evaluate the luminal discrepancy between the graft and the native artery.


RESULTS
In the 122 patients who underwent angiographies about one month after the operation, the patency rate was 99% (144 of 145) in the RA, 97% (139 of 143) in the left internal thoracic artery graft (LITA), 96% (75 of 78) in the saphenous vein graft (SV). In the 23 patients who underwent mid-term angiographies, the patency rate was 91% (24 of 26) in the RA, 100% (23 of 23) in the LITA, and 83% (20 of 24) in the SV. The luminal diameters of the RA and LITA significantly increased from 2.15 to 2.52 mm, and from 1.75 to 1.97 mm, respectively. The luminal change from 3.78 to 3.33 mm in the SV was not significant. The G/N ratios changed from 1.10 to 1.31, from 1.01 to 1.13, and from 2.05 to 1.86 in the RA, LITA, and SV, respectively. The change of the RA alone was statistically significant.


CONCLUSIONS
The angiographic early patency rate was almost the same in three kinds of graft material, but the mid-term patency rate of the RA was between those of the LITA and SV. The mid-term luminal dilatation of the RA could involve two conflicting characteristics, namely, a good intimal function and a propensity to increase in the luminal discrepancy. Therefore, a further observation is required to evaluate whether the clinical outcome of the RA could remain as good as that of the LITA in the long-term period.
Ikeda
Masahiro
M
Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228, Fukui 910-0833, Japan. ikeda@toyama-med.jrc.or.jp
Ohashi
Hirokazu
H
Tsutsumi
Yasushi
Y
Hige
Katsuaki
K
Kawai
Takahiro
T
Ohnaka
Masateru
M
D000368:Aged; D000714:Anastomosis, Surgical; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017534:Radial Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000637:transplantation*; D014654:Vascular Patency