Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years: Results from the Radial Artery Patency and Clinical Outcomes trial

Abstract

At mean 5-year angiography in largely asymptomatic patients, the selection of arterial or venous conduit for the second graft has not significantly affected patency. This finding offers surgeons, for now, enhanced flexibility in planning revascularization.

Vein graft failure: current clinical practice and potential for gene therapeutics

“…12 In a recent randomised controlled trial conducted at 11 Veterans Affairs medical centres in United States undergoing first-time elective CABG, 13 the 1-year graft patency of the radial artery conduits was not significantly greater than venous grafts. In fact, the 7-year patency rates for the vein grafts were also similar to the radial artery conduits in a randomised Australian trial 11 as well as in a retrospective French series with 20-year follow-up. 14 The relevance of vein graft failure, therefore, should not be overlooked.…”

“…Furthermore, distal coronary 'run-off' can affect the long-term vein graft patency. [10][11][12] As the severity of disease in the native coronary recipient artery increases, distal run-off may reduce. In the Radial Artery Patency and Clinical Outcomes (RAPCO) trial, saphenous vein graft patency (measured by the protocol-directed angiograms) was demonstrated in 80% of subjects at 9 years.…”

“…In the Radial Artery Patency and Clinical Outcomes (RAPCO) trial, saphenous vein graft patency (measured by the protocol-directed angiograms) was demonstrated in 80% of subjects at 9 years. 11 However, on closer examination it is apparent that one of the predictors of vein graft patency was an anastomosis with the left anterior descending coronary artery, which is now rarely performed. The initial calibre of the recipient coronary artery (that is, a diameter of at least 2 mm) is another predictor of long-term graft patency.…”

Right internal thoracic artery or radial artery? A propensity-matched comparison on the second-best arterial conduit

“…Outcome (RAPCO) [3] which randomized 196 patients to the RITA and 193 patients to the RA. At midterm follow-up no significant differences in terms of angiographic patency and clinical outcome were found.…”

“…In particular, whether the use of the right internal thoracic artery (RITA) confers a survival advantage when compared to the radial artery (RA) still needs to be determined [3]. To date, only a single randomized controlled trial (RCT) [3] has been published in the literature, largely underpowered to detect any difference in long term survival between RITA and RA groups. Several observational studies comparing RITA versus RA have been reported with conflicting findings [5][6][7][8][9][10][11][12].…”