Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics

Abstract

Radial artery (RA) is the most popular arterial graft after the left internal thoracic artery in both low- and high-risk patients undergoing coronary artery bypass grafting. Various arterial grafts such as the right internal thoracic artery, the right gastroepiploic artery, and the inferior epigastric artery have also gained ground over the past 30 years because of the intimal hyperplasia and atherosclerosis of the saphenous vein leading to late graft occlusion. In this review article we would like to present the utility of the RA as a graft, focused mainly on its structural and biological characteristics.

Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies

“…2) Other studies report a 91.9% permeability with the AIA, 90.1% with the CX, and 83.1% with RCA. 47) Radial artery Carpentier (1973) was the first to use RA for CABG, 2,4,[47][48][49] and is currently considered the second best conduit after the ITA. 4,5,47,50) In recent years, it has gained popularity as a graft for CABG because of its multiple morphological and surgical advantages that make it superior to other conduits.…”

“…47) Radial artery Carpentier (1973) was the first to use RA for CABG, 2,4,[47][48][49] and is currently considered the second best conduit after the ITA. 4,5,47,50) In recent years, it has gained popularity as a graft for CABG because of its multiple morphological and surgical advantages that make it superior to other conduits. 4,5,50,51) The features that make it a versatile graft for CABG are as follows: its vast length to reach distal coronary branches and perform multiple anastomoses, 4,5,47,48,50) a thickness that makes it comfortable to handle and easy to anastomose, 4,5,48,50) a diameter comparable to the coronary arteries, 4,47,48,50) its ability to adapt to high blood pressure, 48) its removal is safe and easy, 4,5,47,48,52) and a remarkable permeability at short, medium, and long term.…”

“…4,5,50,51) The features that make it a versatile graft for CABG are as follows: its vast length to reach distal coronary branches and perform multiple anastomoses, 4,5,47,48,50) a thickness that makes it comfortable to handle and easy to anastomose, 4,5,48,50) a diameter comparable to the coronary arteries, 4,47,48,50) its ability to adapt to high blood pressure, 48) its removal is safe and easy, 4,5,47,48,52) and a remarkable permeability at short, medium, and long term. 2,4,5,47,52) On the other hand, the RA does have some disadvantages; the important one is that due to its thick muscular tunica media, it is prone to early spasms. 4,5,47,48,50,51) However, the use of specific surgical techniques and pharmacological prophylaxis may prevent it.…”

“…2,4,5,47,52) On the other hand, the RA does have some disadvantages; the important one is that due to its thick muscular tunica media, it is prone to early spasms. 4,5,47,48,50,51) However, the use of specific surgical techniques and pharmacological prophylaxis may prevent it. 5,47) Additionally, the prevalence of atherosclerosis and intimal hyperplasia is higher in RA than in the ITA and it can also present calcification in the tunica media (Monckeberg's Sclerosis) with a prevalence of 25%.…”

“…4,5,47,48,50,51) However, the use of specific surgical techniques and pharmacological prophylaxis may prevent it. 5,47) Additionally, the prevalence of atherosclerosis and intimal hyperplasia is higher in RA than in the ITA and it can also present calcification in the tunica media (Monckeberg's Sclerosis) with a prevalence of 25%. 50,51) The most widely accepted indication for RA use is revascularization of the second most important coronary artery in patients where the use of both ITA is contraindicated.…”