1
|
Wang Z, Liu H, Huan Z, Su C, Chen Y, Wei M. Application of the radial artery after angiography in patients undergoing total arterial coronary revascularization. J Cardiothorac Surg 2024; 19:417. [PMID: 38961485 PMCID: PMC11221012 DOI: 10.1186/s13019-024-02893-7] [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] [Received: 03/09/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE There is growing evidence supporting the utilization of the radial artery as a secondary arterial graft in coronary artery bypass grafting (CABG) surgery. However, debates continue over the recovery period of the radial artery following angiography. This study aims to evaluate the clinical outcomes and experiences related to the use of the radial artery post-angiography in total arterial coronary revascularization. METHODS A retrospective analysis was performed on data from patients who underwent total arterial CABG surgery at the University of Hong Kong Shenzhen Hospital from July 1, 2020, to September 30, 2022. Preoperative assessments included ultrasound evaluations of radial artery blood flow, diameter, intimal integrity, and the Allen test. Additionally, pathological examinations of the distal radial artery and coronary artery CT angiography were conducted, along with postoperative follow-up to assess the safety and efficacy of using the radial artery in patients undergoing total arterial CABG. RESULTS A total of 117 patients, compromising 102 males and 15 females with an average age of 60.0 ± 10.0 years, underwent total arterial CABG. The internal mammary artery was used in situ in 108 cases, while in 4 cases, it was grafted to the ascending aorta due to length limitations. Bilateral radial arteries were utilized in 88 patients, and bilateral internal mammary arteries in 4 patients. Anastomoses of the proximal radial arteries to the proximal ascending aorta included 42 cases using distal T-anastomosis and 4 using sequential grafts. The interval between bypass surgery and coronary angiography ranged from 7 to 14 days. Pathological examination revealed intact intima and continuous elastic membranes with no significant inflammatory infiltration or hyperplastic lumen stenosis in the radial arteries. There were no hospital deaths, 3 cases of perioperative cerebral infarction, 1 secondary thoracotomy for hemorrhage control, 21 instances of intra-aortic balloon pump (IABP) assistance, and 2 cases of poor wound healing that improved following debridement. CT angiography performed 2 weeks post-surgery showed no internal mammary artery occlusions, but 4 radial artery occlusions were noted. CONCLUSION Ultrasound may be used within 2 weeks post-angiography to assess the recovery of the radial artery in some patients. Radial arteries with intact intima may be considered in conjunction with the internal mammary artery for total arterial coronary CABG. However, long-term outcomes of these grafts require further validation through larger prospective studies.
Collapse
Affiliation(s)
- Zanxin Wang
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Haibing Liu
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Zhifu Huan
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Chao Su
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Yao Chen
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Minxin Wei
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China.
| |
Collapse
|
2
|
Clarke NS, Jagannathan G, Lawton JS. Long-term consequences of transradial catheterization on the radial artery. J Card Surg 2021; 36:4796-4798. [PMID: 34626437 DOI: 10.1111/jocs.16049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The radial artery (RA) is often utilized for diagnostic coronary angiography and percutaneous intervention. Recent high-level evidence supports RA use in preference to the saphenous vein as a conduit for coronary revascularization. AIM To demonstrate gross and histologic changes of the RA following transradial (TR) access. METHODS We present two patients who had open RA harvest for coronary bypass surgery after TR catheterization. RESULTS Examination 8 years after TR catheterization demonstrated thickened intima and dissection, and examination 12 years following TR catheterization with percutaneous coronary intervention demonstrated chronic dissection with thickened intima and near occlusion of the lumen. CONCLUSION TR access via the RA, even after several years, is associated with significant injury, making it unusable as a conduit for surgical coronary revascularization. A RA that has been utilized for catheterization should not be considered for coronary revascularization.
Collapse
Affiliation(s)
- Nicholas S Clarke
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Geetha Jagannathan
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A, Nasso G, Raman J, Buxton B, Hayward PA, Moat N, Collins P, Webb C, Peric M, Petrovic I, Yoo KJ, Hameed I, Di Franco A, Moscarelli M, Speziale G, Girardi LN, Hare DL, Taggart DP. The RADial artery International ALliance (RADIAL) extended follow-up study: rationale and study protocol. Eur J Cardiothorac Surg 2020; 56:1025-1030. [PMID: 31535147 DOI: 10.1093/ejcts/ezz247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 02/05/2023] Open
Abstract
It is generally accepted that radial artery (RA) grafts have better mid-term patency rate compared to saphenous vein grafts. However, the clinical correlates of the improved patency rate are still debated. Observational studies have suggested increased survival and event-free survival for patients who receive an RA rather than a saphenous vein, but they are open to bias and confounders. The only evidence based on randomized data is a pooled meta-analysis of 6 randomized controlled trial comparing the RA and the saphenous vein published by the RADial artery International Alliance (RADIAL). In the RADIAL database, improved freedom from follow-up cardiac events (death, myocardial infarction and repeat revascularization) was found at 5-year follow-up in the RA arm. The most important limitation of the RADIAL analysis is that most of the included trials had an angiographic follow-up in the first 5 years and it is unclear whether the rate of repeat revascularization (the main driver of the composite outcome) was clinically indicated due to per-protocol angiographies. Here, we present the protocol for the long-term analysis of the RADIAL database. By extending the follow-up beyond the 5th postoperative year (all trials except 1 did not have angiographic follow-up beyond 5 years), we aim to provide data on the role of RA in coronary artery bypass surgery with respect to long-term outcomes.
Collapse
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Stephen Fremes
- Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Karla Ballman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | | | - Jai Raman
- Austin Hospital, Melbourne, VIC, Australia
| | - Brian Buxton
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Philip A Hayward
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Neil Moat
- NHLI, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Peter Collins
- NHLI, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Carolyn Webb
- NHLI, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Miodrag Peric
- Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia
| | - Ivana Petrovic
- Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia
| | - Kyung J Yoo
- Yonsei University College of Medicine, Seoul, South Korea
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - David L Hare
- Austin Hospital, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Right internal thoracic or radial artery as the second arterial conduit for coronary artery bypass surgery. Curr Opin Cardiol 2019; 34:564-570. [PMID: 31219879 DOI: 10.1097/hco.0000000000000654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize the available evidence on the use of the right internal thoracic artery (RITA) and the radial artery as the second arterial graft in coronary artery bypass surgery. RECENT FINDINGS The current data support the equipoise of the two conduits in terms of clinical and angiographic outcomes. Both RITA and radial artery have better patency than saphenous vein grafts. The use of the RITA carries an increased risk of deep sternal wound infection (DSWI) if the artery is harvested as pedicle. Bilateral internal thoracic artery grafting is more technically demanding than radial artery use and there is a volume-outcome relationship in terms of mortality and incidence of DSWI. The radial artery is preferable over RITA in right-sided or distal circumflex artery targets with high-degree stenosis and in patients at higher risk for DSWI, whereas it is not recommended to graft vessels with moderate stenosis and in cases of insufficient collateralization from the ulnar artery or previous transradial procedures. SUMMARY The patency rate and clinical outcomes of radial artery and RITA are similar. The use of one or the other should be based on a careful evaluation of the patient's coronary anatomy and comorbidities, the conduit availability and the surgeon's and center's experience.
Collapse
|
6
|
Ruel M, Sun LY. Post-Operative Calcium-Channel Blocker Use After Radial Artery Grafting: Do We Now Have a Definitive Answer? J Am Coll Cardiol 2019; 73:2307-2309. [PMID: 31072575 DOI: 10.1016/j.jacc.2019.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|