HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Charles A. Dietl Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dietl, C. A. Search for Related Content PubMed Articles by Dietl, C. A. Related Collections Related Article

Ann Thorac Surg 1998;66:1976-1977
© 1998 The Society of Thoracic Surgeons

---

Invited Commentary

^a Cardiothoracic Surgery, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA

Invited commentary

I read with great interest the article by Chester and associates, designed to compare the vascular reactivity of the proximal and distal segments of the radial artery. The authors observed that the contractility of proximal and distal portions of the radial artery was significantly greater than that of the LIMA and RIMA. This is no surprise, because the radial artery is characterized by a thicker muscular wall compared with other arterial conduits.

The authors also observed that the proximal segments of the radial artery also generated more tension than distal segments of the radial artery, when challenged with KCl solution. They conclude that the proximal segments of the radial artery are more prone to vasoconstriction.

However, the authors’ own study shows that the proximal radial artery had a much greater mean cross-sectional area compared with that of the distal radial artery (Table 2). Therefore, blood flow in the distal radial artery may be much less than in the proximal radial artery despite the greater contractility of the proximal segment.

In my clinical experience with almost 400 radial artery grafts, I observed that the distal portions of the radial artery are more prone to spasm than the proximal segments. An identical situation occurs with all the arterial conduits, including internal thoracic arteries [1], gastroepiploic arteries [2], and inferior epigastric arteries, in which the most distal segment is more prone to spasm and should be discarded. In my opinion, the same occurs with the radial artery graft if there is excess length of radial artery available for grafting, we usually discard the distal segment.

Furthermore, exposure of radial artery grafts to high concentrations of KCl is usually avoided in clinical practice. For example, I do not administer any type of cardioplegic solution into radial artery grafts.

References

1. He G.W. Contractility of the human internal mammary artery at the distal section increases toward the end: emphasis on not using the end of the internal mammary artery for grafting. J Thorac Cardiovasc Surg 1993;106:406-411.[Abstract]
2. Dietl C.A. Vascular reactivity of the gastroepiploic artery. J Thorac Cardiovasc Surg 1995;110:1568-1569.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Charles A. Dietl Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dietl, C. A. Search for Related Content PubMed Articles by Dietl, C. A. Related Collections Related Article