title: Radial Artery as a Coronary Artery Bypass Conduit: 20-Year Results.
abstract: There is a lack of evidence for the choice of the second conduit in coronary surgery. The radial artery (RA) is a possible option, but few data on very-long-term outcomes exist.
  
  
  
  This study describes 20-year results of RA grafts used for coronary artery bypass grafting and the effects of RA removal on forearm circulation.
  
  
  
  We report the results of the prospective 20-year follow-up of the first 100 consecutive patients who received the RA as a coronary bypass conduit at our institution.
  
  
  
  Follow-up was 100% complete. There were 64 deaths, 23 (35.9%) from cardiovascular causes. Kaplan-Meier 20-year survival was 31%. Of the 36 survivors, 33 (91.6%) underwent RA graft control at a mean of 19.0 ± 2.5 years after surgery. The RA was found to be patent in 24 cases (84.8% patency). In the overall population, probability of graft failure at 20 years was 19.0 ± 0.2% for the left internal thoracic artery (ITA), 25.0 ± 0.2% for the RA, and 55.0 ± 0.2% for the saphenous vein (p = 0.002 for RA vs. saphenous vein, 0.11 for RA vs. ITA, and p < 0.001 for ITA vs. saphenous vein). Target vessel stenosis >90%, but not location of distal anastomosis, significantly influenced long-term RA graft patency. No patients reported hand or forearm symptoms. The ulnar artery diameter was increased in the operated arm (2.44 ± 0.43 mm vs. 2.01 ± 0.47 mm; p < 0.05) and correlated with the peak systolic velocity of the second palmar digital artery (Pearson coefficient: 0.621; p < 0.05).
  
  
  
  The 20-year patency rate of RA grafts is good, and not inferior to the ITA, especially when the conduit is used to graft a vessel with >90% stenosis. RA harvesting does not lead to hand or forearm symptoms, even at a very-long-term follow-up.
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. Electronic address: mfg9004@med.cornell.edu.
authors: Mario
authors: M
authors: Gaudino
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Paolo
authors: P
authors: Tondi
authors: Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
authors: Umberto
authors: U
authors: Benedetto
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Valentina
authors: V
authors: Milazzo
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Roberto
authors: R
authors: Flore
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Franco
authors: F
authors: Glieca
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Francesca Romana
authors: FR
authors: Ponziani
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Nicola
authors: N
authors: Luciani
authors: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors: Leonard N
authors: LN
authors: Girardi
authors: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors: Filippo
authors: F
authors: Crea
authors: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors: Massimo
authors: M
authors: Massetti
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: angiography; follow-up studies; internal thoracic artery; prospective studies; saphenous vein