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Ann Thorac Surg 1995;60:109-110
© 1995 The Society of Thoracic Surgeons

Discussion

The first 300 words of the full text of this article appear below.

	Introduction

 
See also page 102.

DR HENDRICK B. BARNER (St. Louis, MO):This excellent presentation by Dr Dietl represents the first North American experience with the radial artery since it was abandoned 20 years ago because of poor patency in the first year after grafting. However, the dismal experience of the 1970s has been abrogated by the 94% patency at 6 to 16 months as reported by Acar in Paris and by Calafiore in Chieti, Italy, as well as the unpublished experience of Richard Brodman of Montefiore Hospital in Manhattan, who has obtained 98% patency in 50 radial artery conduits studied 1 to 28 weeks postoperatively. Thus, a better understanding of the necessity to avoid surgical trauma to conduits generally and the recognized need for morphologic and functional preservation of the endothelium probably have been responsible for the improved patency of the current era.

Doctor Dietl, I would be interested in knowing your acceptable time limits for capillary refilling that were employed to interpret the preoperative Allen test. You indicate in the manuscript that 3 patients had a positive intraoperative Allen test and that dissection of the radial artery was abandoned. Does this mean that the preoperative Allen test did not exclude the use of the radial artery in these patients, or are you using the intraoperative Allen test to assess collateral circulation to the hand?

The manuscript reports ``gentle dilation of the radial artery with heparinized saline solution.'' ``Gentle'' can be interpreted broadly, and I would be concerned about the use of excessive pressure with extravasation of saline solution into the arterial wall as well as endothelial damage. Physiologic saline solution, unless buffered, has an acid pH and is known to be injurious to endothelium. Without angiographic control in your patients we do not know if these variables might have affected . . . [Full Text of this Article]