| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:1621-1622
© 2004 The Society of Thoracic Surgeons
Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, Munich 80636, Germany
wildhirt{at}gmx.net
The radial artery is used widely as a conduit for myocardial revascularization. However, little is known about the prevalence of preexisting disease in this vessel and the relation of preexisting disease to risk factors for arteriosclerosis.
The paper by Chowdhury and coworkers in this issue of The Annals describes their morphometric studies to (1) determine the presence of preexisting atherosclerotic disease in human radial arteries, (2) define the predominant location of atherosclerotic lesions within the conduit, and 3) analyze the association with classic risk factors for arteriosclerosis.
The authors' main findings demonstrate that the great majority of harvested radial artery grafts have significant atherosclerotic disease that is associated with classic risk factors, including age, diabetes, and smoking. The predominant location of the diseased segments is the distal part, which shows more severe intimal hyperplasia. The authors suggest that the distal segments of the radial artery graft should be discarded whenever possible.
The present study adds new information to what has been described in the literature. A recent report by Ruengsakulrach and colleagues [1] compared human radial arteries and internal thoracic arteries with regard to histopathology, morphometry, and risk factors for arteriosclerosis and found that the radial artery is more likely to have arteriosclerosis. In line with the present report, those authors found an association with established risk factors for arteriosclerosis including age, diabetes, and smoking.
In spite of the prevalence of preexisting atherosclerotic disease in radial arteries, one question may be of importance: do radial artery grafts possess a better intrinsic tendency to remain patent over the long term compared with vein grafts?
Recent studies showed that the radial artery used as a second graft compared with vein grafts in patients undergoing coronary artery bypass graft surgery with left internal thoracic artery to left anterior descending artery had improved long-term outcomes [2, 3]. In addition, it has been demonstrated that the radial artery not only possesses excellent long-term patency rates but also shows preserved endothelial function and rarely develops flow-limiting, fibrous, intimal hyperplasia [4–6]. In some of these studies, however, radial arteries with preexisting disease were excluded. In spite of the findings reported by Chowdhury and colleagues that the majority of radial arteries have preexisting arteriosclerosis, future studies are needed to evaluate disease progression in these arteries used as conduits. Until then, the radial artery needs to be carefully evaluated for preexisting disease, and diseased segments should not be used as grafts for myocardial revascularization.
References
This article has been cited by other articles:
|
|
 |
|
  L. J. Chesterton, M. K. Sigrist, T. Bennett, M. W. Taal, and C. W. McIntyre Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness Nephrol. Dial. Transplant., June 1, 2005; 20(6): 1140 - 1147. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
