Radial Artery Grafting When to do it ( when to not do it )

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Presentation transcript:

Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular Surgery Sheik Hamdam Bin Rashid Al Maktoum Distinguished Chair Cleveland Clinic Lerner College of Medicine

Radial Artery Advantages Relative large size Few wound complications Easy to work with Prepare simultaneously with ITA Long

Radial Artery Disadvantages Sclerosis in diabetics Damage by radial arterial lines Ulnar flow may be insufficient ? Patency Coronary Artery Competitive Flow

Study Patients 190 Intervention Radial artery grafting Setting Single center Time period 1996 to 2002 F/U 6 years Endpoint Angiographic graft patency 6

Graft Patency ITA, Radial, SVG 100 90 LITA (398) 80 % 70 Radial (242) 60 Vein (588) 50 12 24 36 48 60 72 Months after CABG Zacharias, et. al., Circ, 2004

Study Patients 109 Intervention Radial artery grafting Composite “T” graft from ITA Setting Single center Time period 1993 to 2001 Mean F/U 27.1 months Endpoint Angiographic patency 9

Radial Artery Patency Coronary Artery 100 LAD 80 Cx 60 % 40 RCA 20 12 24 36 48 Time (months) Maniar et al: JTCS 2002

Radial Artery Patency Proximal Coronary Stenosis 100 90-100% 80 60 % 71-89% 40 <70% 20 12 24 36 48 Time (months) Maniar et al: JTCS 2002

Study Patients 68 Intervention Radial artery grafting Aortic proximal Setting Single center Time period 1993 to 1998 Mean F/U 59 +/- 6.5 mths Endpoint 5 year angiographic patency 13

Radial Grafts Patency Target-Vessel Stenosis 100 Occluded String Patient with irregularities Perfectly patent 80 60 RA Grafts (%) 40 20 50-60 70-80 80-90 >90 Target vessels stenosis (%) Possati et al: JTCS 1998

Radial Artery Patency Critically Stenosed Left Coronaries 100 ITA (n=144) 80 RA (n=43) 60 % 40 20 p=0.19 12 24 36 48 Time (months) Maniar et al: JTCS 2002

Radial Artery Patency Moderately Stenosed RCA 100 ITA (n=144) 80 60 % 40 RA (n=30) 20 p<0.001 12 24 36 48 Time (months) Maniar et al: JTCS 2002

Summary Target Vessel and Target vessel stenosis (competitive flow) important predictors of radial artery patency Best when used to graft severely stenotic left sided coronary arteries Worst when used to graft moderately stenosed right sided coronary arteries