Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?

Abstract

AbstrAct:The radial artery (RA) is a commonly used conduit for coronary artery bypass grafting, and recent studies have demonstrated that it provides superior long-term patency rates to the saphenous vein in most situations. In addition, the RA is also being used with increasing frequency as the access point for coronary angiography and percutaneous coronary interventions. However, there has been concern for many years that these transradial procedures may have a detrimental impact on the function of RA grafts used in coronary artery bypass grafting, and there is now comprehensive evidence that such interventions cause morphologic and functional damage to the artery in situ. Despite this, there remain remarkably few studies investigating the use of previously cannulated RAs as grafts in coronary artery bypass surgery, and there are no clear guidelines on the use of the RA in coronary artery bypass grafting after its catheterization. This article will review concisely the evidence that transradial procedures cause damage to the RA, and discuss the impact this could have on previously cannulated RAs used as coronary artery bypass grafting conduits. On the basis of the evidence assessed, we make a number of recommendations to both surgeons and cardiologists regarding use of the RA in cardiovascular procedures.

Long-term endothelial dysfunction after trans-radial catheterization: A meta-analytic approach

“…One older study by Kamiya et al reported significantly lower patency rates of catheterized RAs. Mounsey et al have recently highlighted the lack of clinical evidence and the need for further research on this issue. Our findings lend further support to the advocates of the non‐use of catheterized RAs as grafts during CABG, for at least several months following catheterization …”

“…This temporal change in interventional cardiology clinical practice is important since the radial artery (RA) is the second most common arterial graft next to the internal mammary artery in patients undergoing coronary artery bypass grafting (CABG). Even though the right RA is the initial access site for radial catheterization, in >10% of cases the left RA can also be used …”

“…Results from clinical studies on this issue are conflicting . Long‐term endothelial and/or smooth muscle cell dysfunction could have implications for the use of catheterized RA as grafts in patients undergoing CABG . Previous studies have reported significantly lower graft patency rates of catheterized RAs …”

“…Even though the right RA is the initial access site for radial catheterization, in >10% of cases the left RA can also be used. 2 Evidence suggests that the use of radial access for coronary catheterization may adversely affect RA function due to mechanical injury and inflammation-related processes at the access site. [3][4][5][6][7] Immunohistochemistry studies of RAs report a loss of endothelial integrity post-catheterization 8 and optical coherence tomography (OCT) imaging of cannulated RAs demonstrates morphological deformations and intimal tears.…”

The use of the radial artery following transradial catheterization-A word of caution

“…However, Gaudino and colleagues have demonstrated that transradial catheterization results in both mechanical and inflammatory changes that disrupt endothelial integrity . Previous studies have reported lower patency rates when the radial artery conduit has been used following a recent cardiac catheterization …”