title: Reappraisal of a 20-year experience with the radial artery as a conduit for coronary bypass grafting.
abstract: OBJECTIVE
  This study aimed at evaluating the clinical and angiographic results of the radial artery (RA) used as a coronary bypass graft over 20 years.
  
  
  METHODS
  Clinical follow-up was obtained in 563 patients at 9.2 years. Angiographic follow-up was obtained in 351 patients with opacification of 1427 conduits, including 629 RA at 7.0 years.
  
  
  RESULTS
  At 9.2 years, freedom from overall and cardiovascular death was 80.3% and 92.7%, respectively. Symptoms were: acute myocardial infarction: 2.1% (n=12); angina: 17.4% (n=98), and congestive heart failure 10.6% (n=60). Percutaneous revascularization was required in 13.5% (n=76) of cases on: native coronary (n=77), RA conduit (n=21), and other graft (n=7). Reoperation was needed in 2.3% (n=13) of cases for valve replacement (n=10) and redo coronary artery bypass grafting (CABG) (n=3). At 7.0 years, RA patency was 82.8% (521/629) and was lower than that of left internal mammary artery (IMA), 95.5% (491/514) (p<0.001); similar to right IMA, 87.9% (51/58, p=0.32); free IMA, 80.0% (44/55, p=0.60); and vein, 81.9% (140/171, p=0.77). RA patency was lower in the case of myocardial ischemia: 74.0% (174/235) versus 88.1% (347/394) in asymptomatics (p<0.001). RA patency was higher for diagonal (93.1% (95/102)) compared to circumflex (82.5% (274/332, p<0.01)) and right coronary (77.6% (146/188, p<0.001)). Calcium channel blockers had no impact on RA patency. Separating four groups at successive follow-up intervals, RA patency was: 86.2%, 81.9%, 81.4%, and 81.6% at 1.0, 5.4, 8.3, and 13.1 years, respectively.
  
  
  CONCLUSIONS
  CABG with the RA offered long-lasting clinical benefit. Beyond the first postoperative year during which some attrition was observed, RA patency was remarkably stable for up to 20 years.
authors: Department of Cardiovascular Surgery, Hôpital Georges Pompidou, Paris, France.
authors: Paul
authors: P
authors: Achouh
authors: Khaled Ould
authors: KO
authors: Isselmou
authors: Redha
authors: R
authors: Boutekadjirt
authors: Cosimo
authors: C
authors: D'Alessandro
authors: Jean-Yves
authors: JY
authors: Pagny
authors: Regis
authors: R
authors: Fouquet
authors: Jean-Noël
authors: JN
authors: Fabiani
authors: Christophe
authors: C
authors: Acar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000637:transplantation*; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency