Ann Thorac Surg 2008;85:894-895. doi:10.1016/j.athoracsur.2007.11.044
© 2008 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited Commentary
Walter J. Gomes, MD
Cardiovascular Surgery Discipline, Escola Paulista de Medicina, Federal University of São Paulo, Rua Botucatu, 740, São Paulo-SP 04023-900, Brazil
(Email: wjgomes.dcir{at}epm.br).
This article by Royse and colleagues [1], investigating the ulnar artery for evidence of accelerated atherosclerosis after radial artery harvesting for coronary artery bypass grafting, is an interesting and straightforward study, shedding some light on a hot issue.
With the demonstration of improved survival in patients undergoing arterial revascularization, the use of the radial artery is becoming increasingly common as a second or third arterial conduit in association with the internal thoracic artery grafts. Previous reports raised the debate whether harvesting a radial artery graft might induce structural changes leading to further acceleration of the atherosclerosis process in the ipsilateral ulnar artery, potentially contributing to long-term vascular impairment of the forearm or hand [2, 3]. The compensatory increase in the ulnar artery blood flow derived from the radial artery harvesting might lead to an accelerated progression in the atherosclerosis process. The concern induced by this finding has alarmed many surgical teams worldwide about the safety to continue using this conduit in coronary artery bypass surgery.
The present study used high-frequency ultrasound imaging to examine the late changes (mean of 8.4 years postoperative) in the ipsilateral ulnar artery in patients whose radial artery had been harvested compared with the contralateral ulnar artery. The authors were able to demonstrate no considerable differences in structural or functional indicators over the long term, therefore reassuring that the ulnar artery is relatively preserved from accelerated atherosclerosis long after radial artery harvesting.
The conclusion of the study is important by frontally opposing and refuting the information generated by previous works; therefore, it is a timely and important contribution. Definitely, further studies aiming to help settling this debate are justified and welcome.
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References
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- Royse AG, Chang GS, Nicholas DM, Royse CF. No late ulnar artery atheroma after radial artery harvest for coronary artery bypass surgery Ann Thorac Surg 2008;85:891-895.[Abstract/Free Full Text]
- Gaudino M, Glieca F, Luciani N, et al. Ten-year Echo-Doppler evaluation of forearm circulation following radial artery removal for coronary artery bypass grafting Eur J Cardiothorac Surg 2006;29:71-73.[Abstract/Free Full Text]
- Gaudino M, Serricchio M, Tondi P, et al. Chronic compensatory increase in ulnar flow and accelerated atherosclerosis after radial artery removal for coronary artery bypass J Thorac Cardiovasc Surg 2005;130:9-12.[Abstract/Free Full Text]
Related Article
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No Late Ulnar Artery Atheroma After Radial Artery Harvest for Coronary Artery Bypass Surgery
- Alistair George Royse, Greg S. Chang, Danielle M. Nicholas, and Colin F. Royse
Ann. Thorac. Surg. 2008 85: 891-894.
[Abstract]
[Full Text]
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