Radial artery patency: are aortocoronary conduits superior to composite grafting?
BACKGROUND
The radial artery (RA) can be used as either an aortocoronary (RA-Ao) or composite graft (T graft). Optimum use for the RA has yet to be established. We compared RA patency with these two techniques.


METHODS
Between October 1993 and June 2001, 1505 patients underwent coronary artery bypass grafting using the RA as either a composite (n = 1022) or RA-Ao graft (n = 483). Angiograms performed on 203 (13.5%) patients with signs or symptoms of ischemia at an average of 26.1 +/- 18.5 months postoperatively were reviewed.


RESULTS
Patients with RA-Ao grafts had a greater incidence of postoperative angiography versus patients with composite grafts (19% versus 11%; p < 0.01). Patients receiving T grafts had a greater number of anastomoses per patient (4.1 +/- 0.6 versus 3.0 +/- 1.0; p < 0.01) and a higher incidence of total arterial revascularization (100% versus 41%; p < 0.01). Regardless of grafting strategy, patency was significantly worse for targets of the right coronary artery (58% T graft; 67% RA-Ao; p < 0.01 for both) and for targets with less than or equal to 70% stenosis (59% T graft; 57% RA-Ao; p < 0.01 for both). The site of proximal anastomosis failed to effect RA patency (relative risk, 1.2; 95% confidence interval, 0.7 to 1.8; p = 0.50).


CONCLUSIONS
The site of the proximal anastomosis does not appear to influence patency. Both RA-Ao and composite conduits are sensitive to target location and stenosis. Advantages of composite grafting include greater conduit length and minimizing aortic manipulation at the expense of increased complexity and the potential for hypoperfusion. These factors should be considered when choosing an RA grafting strategy.
Maniar
Hersh S
HS
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Barner
Hendrick B
HB
Bailey
Marci S
MS
Prasad
Sunil M
SM
Moon
Marc R
MR
Pasque
Michael K
MK
Lester
Martha L
ML
Gay
William A
WA
Damiano
Ralph J
RJ
D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*