Comparison of radial artery patency according to proximal anastomosis site: direct aorta to radial artery anastomosis is superior to radial artery composite grafting.
OBJECTIVE
The radial artery is frequently the second graft of choice after the left internal thoracic artery in coronary artery bypass graft surgery. However, the optimal radial artery proximal anastomosis site remains controversial. The aim of the present study was to compare the radial artery patency according to its use as either an aorta-radial artery graft or composite radial artery graft in coronary artery bypass grafting.


METHODS
A total of 1735 patients received coronary artery bypass grafting using the radial artery between January 2001 and July 2007, of whom 893 received serial computed tomographic coronary angiographies; these patients formed the basis of the current study. The patients were divided into 2 groups: group I (direct radial artery to aortic anastomosis, n = 451 patients) and group II (radial artery composite grafting with the left internal thoracic artery, n = 442 patients). The number of distal radial artery anastomoses performed in group I was 657 and 749 in group II. Sequential bypassing was performed in 399 patients.


RESULTS
The early patency rate was significantly higher in group I than in group II (98.3% vs 94.5%; P = .004). The 1-, 2-, and 5-year patency rates were also higher in group I than in group II (93.8% +/- 1.2%, 90.5% +/- 1.6%, and 74.3% +/- 6.1%, vs 90.5% +/- 1.4%, 85.3% +/- 1.9%, and 65.2% +/- 4.2%, respectively; P = .004). Multivariate analysis showed composite grafting (P = .02), the degree of target vessel stenosis <90% (P = .001), and the target revascularization site (P = .005) to be significant risk factors for occlusion.


CONCLUSIONS
The results of the current data showed superior early and late patency rates of coronary artery bypass grafting with radial artery to aorta anastomosis compared with left internal thoracic artery-radial artery composite grafting.
Jung
Sung-Ho
SH
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
Song
Hyun
H
Choo
Suk Jung
SJ
Je
Hyung Gon
HG
Chung
Cheol Hyun
CH
Kang
Joon-Won
JW
Lee
Jae Won
JW
D000368:Aged; D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006083:Graft Occlusion, Vascular; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency