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The evidence for radial artery grafting: When and when not?

G. Cancelli,K. Audisio,David Chadow,G. Soletti,M. Gaudino

Published 2021 in JTCVS Techniques

ABSTRACT

See Commentary on page 120. More than 18 million adults in the United States have coronary artery disease (CAD), accounting for 7% of the entire American adult population. Coronary artery bypass grafting (CABG) is the most performed type of cardiac surgery with about 370,000 cases annually in the United States. The first ever left internal thoracic artery (LITA) to left anterior descending anastomosis took place in 1968, performed by George Green in New York. Today this procedure has become the gold standard and the patency of this anastomosis correlates most strongly with improved outcomes and better survival. Just few years later, in 1973, Carpentier and colleagues first described the radial artery (RA) as a conduit for CABG. However, he subsequently advised against its use because of a higher rate (35%) of occlusion or narrowing possibly attributed to spasm. Therefore, this graft quickly fell out of favor and would not be used again for approximately 20 years. In 1992, Acar and colleagues demonstrated that occluded or narrowed RA from the first Carpentier series were patent at 18-year follow-up. Furthermore, he studied 122 RA grafts and showed that the early patency was 100%, proving the RA was in fact suitable as a graft in CABG. Since then, the use of the RA has continued to increase for the treatment of patients with multivessel CAD undergoing CABG. Atraumatic harvesting technique, careful selection of the target vessel, and use of antispastic protocols are the likely reasons for the improved results of RA grafting in the cotemporary era.

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