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Carranza CL, Ballegaard M, Werner MU, Hasbak P, Kjaer A, Kofoed K, Olsen MH, Gluud C, Jakobsen JC. Detailed statistical analysis plan for the neurological complications in endoscopic versus open radial artery harvest (NEO) randomised clinical trial. Trials 2022; 23:990. [PMID: 36494849 PMCID: PMC9734608 DOI: 10.1186/s13063-022-06869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Coronary artery bypass grafting can be conducted using the radial artery as a bypass graft. However, it remains unclear which harvesting method is superior, i.e. endoscopic or open radial artery, and which site for proximal anastomosis of the radial artery has the greatest benefits? METHODS The NEO Trial is a single site randomised clinical trial with a 2 × 2 factorial design. The first comparison assesses endoscopic versus open radial artery harvest with a primary outcome of hand function and secondary outcomes of neurological deficits through clinical exams and neurophysiological studies. The primary outcome is postoperatively hand function at three months. We anticipate a mean difference of 3 points with a standard deviation of 8 points, a power of 90%, and a type I error of 5%, resulting in a required sample size of 300 participants randomised 1:1. Secondary outcomes are neurological deficits (based on nerve conduction measurements, algometry test and von Frey hair test), clinical neurological examination of cutaneous sensibility, and registration of complications in the donor arm (haematoma formation, wound dehiscence, and/or infection). The second comparison assesses two different proximal anastomotic sites, i.e. aorto-radial anastomosis versus mammario-radial anastomosis. The primary outcome is a composite of cerebrovascular events and the secondary outcome is graft patency evaluation by multi-slice computer tomography-scan. These outcomes will be assessed at 1 year postoperatively, and the results of this comparison will be exploratory only. Both comparisons will be analysed using intention-to-treat and intervention groups will be compared using linear regression, logistic regression, or Mann-Whitney U test depending on data type. Two independent statisticians will follow the present plan and conduct the analyses which will hereafter be fused into a final analysis based on consensus. CONCLUSION This detailed analysis plan will increase the validity of the NEO trial results by predefining the statistical analysis in detail. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01848886 . Registered 25 February 2013. Danish Ethics committee number: H-3-2012-116. Danish Data Protection Agency: 2007-58-0015/jr. n:30-0838.
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Affiliation(s)
- Christian L. Carranza
- grid.475435.4Department of Cardio-Thoracic Surgery, The Heart Centre, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark
| | - Martin Ballegaard
- grid.476266.7Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Mads U. Werner
- grid.475435.4Multidisciplinary Pain Centre, Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark
| | - Philip Hasbak
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- grid.475435.4Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Kofoed
- grid.475435.4Department of Cardiology and Radiology, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- grid.475435.4Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark ,grid.475435.4Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- grid.475435.4Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- grid.475435.4Centre for Clinical Intervention Research, Copenhagen Trial Unit, The Capital Region, Copenhagen University Hospital − Rigshospitalet, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Nappi F, Bellomo F, Nappi P, Chello C, Iervolino A, Chello M, Acar C. The Use of Radial Artery for CABG: An Update. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5528006. [PMID: 33928147 PMCID: PMC8049807 DOI: 10.1155/2021/5528006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Francesca Bellomo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Camilla Chello
- Regenerative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Adelaide Iervolino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Italy
| | - Massimo Chello
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Christophe Acar
- Department of Cardiac Surgery, La Pitié Salpetriere Hospital, Paris, France
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Lima ML, Silva HSM, Lougon LN, Barros FS, Gomes WJ. Remodeling of ipsilateral ulnar artery after radial artery harvesting for coronary artery bypass graft. Can J Physiol Pharmacol 2021; 99:231-236. [PMID: 33590782 DOI: 10.1139/cjpp-2020-0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are controversies in the literature on the blood supply to the forearm after surgical removal of the radial artery in coronary artery bypass grafting (CABG). The objective was to investigate the arterial remodeling of the ulnar artery after the removal of the radial artery in myocardial revascularization by means of ultrasound examination with color Doppler in the pre- and post-operative periods. This paper describes an observational prospective study of the remodeling of the left brachial and ulnar arteries (donor arm) in 103 right-handed non-consecutive adult patients undergoing CABG with removal of the ipsilateral radial artery using the color Doppler ultrasound examination. In the ulnar artery, a significant increase (P < 0.05) was seen in the following measurements: lumen diameter by 13%, lumen area by 26%, peak systolic flow by 40%, and average flow by 46%. Intima-media thickness measured in the ulnar artery did not show a statistically significant difference (P = 0.22), except in diabetic patients (P = 0.007). We conclude that the ulnar artery undergoes positive physiological remodeling, adapting to the new requirements of chronic increase in flow after the ipsilateral removal of the radial artery to serve as a graft in CABG. There was no evidence of increased intima-media thickness, except in diabetic patients.
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Affiliation(s)
- Melchior L Lima
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Héber S M Silva
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Lourival N Lougon
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Fanilda S Barros
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Walter J Gomes
- Discipline of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
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Royse AG, O'Donnell MJ, Mocioaca L, Sharma V, Ou-Young JC, Canty DJ, Royse CF. Does Radial Artery Harvest for Coronary Surgery Compromise Forearm Blood Flow to 22 Years Post-Operative? J Am Coll Cardiol 2019; 72:1981-1982. [PMID: 30309476 DOI: 10.1016/j.jacc.2018.07.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022]
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Costa AC, Viecili L, Sambuy MTC, Rezende MR, Chakkour I. The Radial Artery's Sacrifice in the Chinese Flap Is Not Deleterious to Patients. Hand (N Y) 2016; 11:357-363. [PMID: 27698641 PMCID: PMC5030853 DOI: 10.1177/1558944715620815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: A widely discussed subject, albeit with few associated studies and publications, centers on whether sacrifice of the radial artery to perform the radial forearm flap (RFF) is deleterious to the patient. The objective of this study was to assess, by questionnaire, the complications reported at the donor site, particularly those related to sacrifice of the radial artery. Methods: During the 2014 Symposium of the Brazilian Society of Reconstructive Microsurgery, surgeons were asked to answer a questionnaire on RFF cases and complications. Results: Results were collected from hand and plastic surgeons. Regarding the opinion of respondents on the deleteriousness of sacrificing the radial artery, most answered negatively, that is, no deleterious effects reported. No statistically significant difference was found between the level of experience and opinion on whether sacrificing the radial artery was deleterious. Conclusions: Beyond performing some procedures and following evolution within a specific service, it was decided to broaden the range of opinions and enlarge the casuistic by assessing the opinions of many specialists from the fields of hand surgery and plastic surgery. Data collected using the questionnaire were compared to determine the sequelae at the donor site and particularly whether sacrifice of the radial artery in RFF was deleterious to the patient. Although complaints at the donor site were frequently cited, no objective reports on morbidity following the sacrifice of the radial artery in RFF were provided.
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Affiliation(s)
| | | | | | | | - Ivan Chakkour
- Santa Casa de São Paulo School of Medical Sciences, Brazil
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Hahalis G, Deftereos S, Bertrand OF. Ulnar artery: The Ulysses ultimate resort for coronary procedures. Hellenic J Cardiol 2016; 57:S1109-9666(16)30146-4. [PMID: 27712911 DOI: 10.1016/j.hjc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.
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Cochrane AD, Royse AG, Smith JA. Advance Australasia Fair: A quarter of a century of contributions to cardiothoracic surgical science. Heart Lung Circ 2016; 25:309-13. [DOI: 10.1016/s1443-9506(16)00047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chim H, Bakri K, Moran SL. Complications related to radial artery occlusion, radial artery harvest, and arterial lines. Hand Clin 2015; 31:93-100. [PMID: 25455360 DOI: 10.1016/j.hcl.2014.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent publications have suggested that there may be an important role for the radial artery regarding long-term perfusion of the hand. The increasing popularity of the radial artery as an access site for cardiac catheterization has also resulted in the recognition of acute and chronic radial artery occlusion, and cardiologists have placed renewed emphasis on preserving the patency of this artery for future interventional procedures. This article reviews the present literature on radial artery harvest and occlusion. Also discussed are the complications associated with radial artery occlusion and treatment options to prevent such complications.
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Affiliation(s)
- Harvey Chim
- Division of Plastic Surgery, University of Miami Medical Center, 1600 Northwest 10th Avenue #1140, Miami, FL 33136, USA
| | - Karim Bakri
- Division of Plastic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Baikoussis NG, Papakonstantinou NA, Apostolakis E. Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics. J Cardiol 2014; 63:321-8. [PMID: 24525045 DOI: 10.1016/j.jjcc.2013.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/01/2013] [Accepted: 11/14/2013] [Indexed: 10/25/2022]
Abstract
Radial artery (RA) is the most popular arterial graft after the left internal thoracic artery in both low- and high-risk patients undergoing coronary artery bypass grafting. Various arterial grafts such as the right internal thoracic artery, the right gastroepiploic artery, and the inferior epigastric artery have also gained ground over the past 30 years because of the intimal hyperplasia and atherosclerosis of the saphenous vein leading to late graft occlusion. In this review article we would like to present the utility of the RA as a graft, focused mainly on its structural and biological characteristics.
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Affiliation(s)
| | | | - Efstratios Apostolakis
- Department of Cardiac Surgery, Ioannina University Hospital, School of Medicine, Ioannina, Greece
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Deshmukh AR, Kaushik M, Aboeata A, Abuzetun J, Burns TL, Nubel CA, White MD, Lanspa TJ, Hunter CB, Mooss AN, Esterbrooks DJ. Efficacy and safety of transulnar coronary angiography and interventions-A single center experience. Catheter Cardiovasc Interv 2013; 83:E26-31. [DOI: 10.1002/ccd.24989] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/23/2013] [Accepted: 05/05/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Anand R. Deshmukh
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Manu Kaushik
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Jamil Abuzetun
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Tammy L. Burns
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Caroline A. Nubel
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Michael D. White
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Thomas J. Lanspa
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Claire B. Hunter
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Aryan N. Mooss
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
| | - Dennis J. Esterbrooks
- Division of Cardiovascular Medicine; Department Internal Medicine; The Cardiac Center of Creighton University; Omaha Nebraska
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Yanagisawa A, Hashikawa K, Sugiyama D, Makiguchi T, Yanagi H, Kumagai S, Yokoo S, Terashi H, Tahara S. Haemodynamic changes in the fingers after free radial forearm flap transfer: a prospective study using SPP. J Plast Reconstr Aesthet Surg 2010; 63:539-43. [DOI: 10.1016/j.bjps.2008.11.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 10/24/2008] [Accepted: 11/09/2008] [Indexed: 11/25/2022]
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Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg 2009; 109:1763-81. [PMID: 19923502 DOI: 10.1213/ane.0b013e3181bbd416] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.
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Affiliation(s)
- Marek Brzezinski
- Anesthesiology Service (129) VA Medical Center, 4150 Clement St., San Francisco, CA 94121, USA.
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Liava'a M, Theodore S, Wagner T, Tatoulis J. Late Presentation Digital Ischemia After Radial Artery Harvest for Coronary Artery Bypass. Ann Thorac Surg 2009; 87:e21-2. [DOI: 10.1016/j.athoracsur.2008.10.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 10/06/2008] [Accepted: 10/21/2008] [Indexed: 11/30/2022]
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Zanow J, Krueger U, Reddemann P, Scholz H. Experimental study of hemodynamics in procedures to treat access-related ischemia. J Vasc Surg 2008; 48:1559-65. [DOI: 10.1016/j.jvs.2008.06.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/09/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
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Vita JA, Holbrook M, Palmisano J, Shenouda SM, Chung WB, Hamburg NM, Eskenazi BR, Joseph L, Shapira OM. Flow-induced arterial remodeling relates to endothelial function in the human forearm. Circulation 2008; 117:3126-33. [PMID: 18541736 DOI: 10.1161/circulationaha.108.778472] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic changes in blood flow stimulate arterial remodeling, which contributes to the maintenance of vascular homeostasis. Experimental studies suggest that remodeling represents a response to local changes in endothelial shear stress and is nitric oxide-dependent. METHODS AND RESULTS To investigate determinants of outward arterial remodeling in humans, we measured ulnar artery flow, diameter, and flow-mediated dilation before and after removal of the adjacent radial artery in 53 patients who were undergoing coronary bypass surgery (age 60+/-11 years; 13% female). Removal of the radial artery increased ulnar artery blood flow by 35% (P=0.009) and increased ulnar artery diameter by 9% (P<0.001) 4 to 8 weeks after surgery. At 1 week, ulnar artery shear stress was increased by 58% (P<0.001), but it was no longer different from baseline at longer-term follow-up. The contralateral ulnar artery was unaffected, which suggests that these findings were not attributable to the systemic effects of medications or the postoperative state. Extent of outward remodeling correlated with the increase in blood flow (r=0.50, P=0.001) and with flow-mediated dilation at baseline (r=0.50, P=0.001). Remodeling correlated inversely with baseline endothelial expression of P-selectin in the radial artery (r=-0.76, P=0.004, n=14). CONCLUSIONS A sustained increase in blood flow in the ulnar artery induced outward arterial remodeling despite the presence of risk factors and coronary artery disease. The remodeling response was related to endothelial phenotype, as reflected by flow-mediated dilation and expression of P-selectin. These findings provide evidence that the endothelium plays an important role in the regulation of vascular structure in humans.
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Affiliation(s)
- Joseph A Vita
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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No Late Ulnar Artery Atheroma After Radial Artery Harvest for Coronary Artery Bypass Surgery. Ann Thorac Surg 2008; 85:891-4. [DOI: 10.1016/j.athoracsur.2007.10.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 11/19/2022]
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Manabe S, Sunamori M. Radial Artery Graft for Coronary Artery Bypass Surgery: Biological Characteristics and Clinical Outcome. J Card Surg 2006; 21:102-14; 115. [PMID: 16426364 DOI: 10.1111/j.1540-8191.2006.00182.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The radial artery (RA) is gaining popularity as a bypass conduit for coronary artery bypass grafting, and its impact on clinical practice has been extensively explored. In the present article, we provide a review of postoperative hand circulation, vascular biological characteristics of the RA graft, the efficacy of vasodilator therapies, and mid-term clinical results of use of the RA graft. Fundamental studies revealed excellent vascular biological characteristics of the RA graft as a living arterial conduit, making it almost equivalent to the internal thoracic artery (ITA) graft. Clinical studies have yielded encouraging mid-term results. Most studies reported in favor of the RA graft over the saphenous vein graft with regard to patency rate, freedom from cardiac events, and survival. However, superiority of either the RA or right ITA graft has not been conclusively determined. The long-term results of RA grafts remain unknown, but at present, supplementary use of an RA graft with a left ITA graft appears feasible for CABG.
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Affiliation(s)
- Susumu Manabe
- Department of Cardiothoracic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo 113-8519, Japan.
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Nezic D, Milojevic P, Cirkovic M, Knezevic A, Novakovic A, Gojkovic-Bukarica L, Jovic M, Djukanovic B. The radial artery for coronary artery bypass grafting. ACTA CHIRURGICA IUGOSLAVICA 2005; 52:11-9. [PMID: 16812988 DOI: 10.2298/aci0503011n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Previous long-term studies have shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularisation, compared with internal mammary artery grafts. Recently, the use of radial artery for CABG has enjoyed a revival, on the basis of the belief that it will help improving long-term results of coronary operations. The recent reports of encouraging mid-term and long-term patency rates of the radial artery, supports its continued use as a bypass conduit. In this paper, we review the current knowledge about the radial artery as a bypass graft, with special emphasis on the clinical results.
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Affiliation(s)
- D Nezic
- Dedinje Cardiovascular Institute, Belgrade
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