Comparative study on the histomorphology and molecular biology of radial artery conduits in patients with diabetes mellitus who underwent coronary bypass surgery

Abstract

We studied the impact of diabetes mellitus (DM) on the radial artery (RA) in 30 patients with DM and 30 non-diabetic patients undergoing coronary artery bypass grafting with autologous RA. RAs were recorded as normal if there was no cellular or stromal tissue between the endothelium and the internal elastic lamina. The RA was normal in 26.7% of diabetic and 76.7% of non-diabetic patients (p = 0.000298). Intimal thickness index and intima:media ratio were higher in the former than in the latter (p < 0.05; p < 0.05), with no significant difference in luminal narrowing (p > 0.05). Electron microscopy scores were lower in the non-diabetic group (p < 0.001); endothelial nitric oxide synthase (eNOS) protein expression and optical density were higher (p < 0.001). Von Willebrand factor and endothelin-1 messenger RNA (mRNA) levels were higher in the DM patients (p < 0.001). The quality of the RA in patients with DM was thus inferior to that in non-diabetic patients. Care should be taken when selecting RA as a conduit in patients with DM.

Electron Microscopic Comparison of Radial Artery Grafts in Non‐Diabetic and Diabetic Coronary Bypass Patients

“…Shah et al reported that each 1% increase in HbA1c or each year of duration of diabetes is associated with approximately 30% increased odds of a thicker carotid intima media thickness. Zou et al found that intimal thickness and intima media ratio are increased in diabetic patient's radial artery grafts in comparison with non diabetics using electron microscopy. Chowdury et al also found increased medial calcification and atherosclerosis of the radial artery grafts in diabetics.…”

Impact of Diabetes Mellitus on Radial and Ulnar Arterial Vasoreactivity after Radial Artery Cannulation: A Randomized Controlled trial

“…Due to easy accessibility and low rate of associated complications, the radial artery is favored in various clinical procedures, such as for a bypass conduit during coronary artery bypass graft (CABG) surgery, 12 , 13 as the site of cardiac catheterization in coronary angiography, 14 and as the route of cannulation for continuous monitoring of arterial pressure. 2 In addition, the artery's vascular response to external stimuli (vasoreactivity) has been investigated extensively.…”

“… 2 In addition, the artery's vascular response to external stimuli (vasoreactivity) has been investigated extensively. 13 , 15 - 17 Radial artery harvest has shown mild reduction in digital perfusion and complementary increase in ulnar artery diameter and flow velocity with no clinical sequelae or compromised hand function. 18 , 19 After catheterization for coronary angiography access, the artery may exhibit reduced lumen density due to wall injuries after cannulation.…”

Comparison of endothelial function of coronary artery bypass grafts in diabetic and nondiabetic patients: Which graft offers the best?

“…In vitro studies have established the association of diabetes with impaired endothelial function and decreased NO bioavailability in RA grafts. Atherosclerotic process in diabetic patients was morphologically and functionally shown to be ahead of non-diabetic RA (28, 29). Optical coherence tomographic imaging of otherwise ‘normal’ RA revealed plaques in 76% of diabetic patients undergoing CABG surgery (30).…”