Ann Thorac Surg 1996;62:479-480
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
R. Leighton Fisk, MD
1520 South Dobson Rd, Suite 308, Mesa, AZ 85202,
See also page 475.
The significant number of patients who require primary or reoperative coronary artery bypass with limitation in available autogenous bypass graft conduit continues to stimulate the evaluation of a variety of graft sources. This article, as well as other recent studies that are referenced in it, justifies renewed enthusiasm for the radial artery graft, a conduit long avoided after discouraging reports by me and others two decades ago.
A reflection today on our early experience should not be allowed to cast serious reservations on these recent results using the radial artery conduit. Indeed, examination of our past methodology serves indirectly to endorse the importance of technical factors that contemporary reports emphasize. Our unsatisfactory outcomes using radial artery grafts resulted when many were harvested using electrocoagulation on the small branches of the artery, probes were passed intraluminally, saline solution was used for distention, calcium-blocking agents were not used, and many anastomoses were performed on the beating heart. Some of these factors are now known to contribute to reduced graft patency regardless of the conduit. At best, our initial trial reflected the delicacy of the radial artery and the reactivity that others have demonstrated with reports of the reversible "string sign" that has been repeatedly observed.
The foregoing report and other recent works have updated and refined techniques that minimize trauma to the graft and modify vasoreactivity by the use of calcium-channel blockers. These measures appear essential to obtain results with the radial artery that are more reliable and acceptable. Resurgence of interest in the radial artery is to be expected. Additional reports of long-term success could well place this graft in a favorable position relative to the internal mammary artery in certain clinical settings. It now appears timely to structure studies that compare the mammary artery pedicle and free grafts with the radial artery. A prospective study with complete angiographic and clinical follow-up will be necessary to establish the relative merits of each bypass configuration.
Additional long-term follow-up information will hopefully soon be forthcoming. Nevertheless, the acceptable low frequency of arm morbidity that is generally observed and the very encouraging results that have been achieved through attention to important details of graft management such as highlighted again by da Costa and associates show the possibility of returning the radial artery graft to respectable status in the repertoire of alternative coronary artery bypass graft conduits.
Related Article
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Myocardial Revascularization With the Radial Artery: A Clinical and Angiographic Study
- Francisco Diniz Affonso da Costa, Iseu Affonso da Costa, Robinson Poffo, Décio Abuchaim, Rogério Gaspar, Lázaro Garcia, and Djalma Luiz Faraco
Ann. Thorac. Surg. 1996 62: 475-479.
[Abstract]
[Full Text]
