Remodeling of the radial artery anastomosed to the internal thoracic artery as a composite straight graft

Fukui, Shinya; Fukuda, Hirotsugu; Toda, Köichi; Yoshitatsu, Masao; Funatsu, Toshihiro; Masai, T.; Miyamoto, Yuji

doi:10.1016/j.jtcvs.2007.07.024

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…Fukui, Calafiore, and Tatoulis consider, based on angiographic results obtained at 12 months, 17.5 months, and 41,5 months postoperatively, that there are no differences in patency rates and prognosis between free ITAs with composite anastomosis and in situ ITAs on one hand and between pedicled and skeletonised grafts on the other hand (19–21). In our study, in situ RITA was used exclusively for the RCA territory and free ITAs as composite grafts for the anterolateral or CX territory, thus introducing another variable in the equation, the coronary territory.…”

Section: Discussionmentioning

confidence: 99%

Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

Tinică¹,

Chistol²,

Iliescu

et al. 2018

Exp Ther Med

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The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.

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Section: Discussionmentioning

confidence: 99%

Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

Tinică¹,

Chistol²,

Iliescu

et al. 2018

Exp Ther Med

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“…NO released from endothelium plays a crucial role in the remodeling of vascular diameter depending on shear stress [ 18 ]. Fukui and colleagues [ 19 ] reported that a non-skeletonized RA graft adjusts its caliber to suit the flow requirement, which eventually normalizes shear stress at the endothelial interface and allows the conduit to deliver an appropriate flow. Low shear stress induces the attachment of endothelial cells and leukocytes, resulting in thrombus, intimal hyperplasia, and subsequent graft failure [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Change of luminal diameter of skeletonized and non-skeletonized radial artery graft at early and late postoperative period

et al. 2015

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The radial artery is increasingly used as a second arterial conduit for myocardial revascularization. However, the radial artery is susceptible to vasospasm, which is thought to be the principal cause of graft failure. The radial artery is harvested as a skeletonized or a non-skeletonized graft, but the effect of different harvesting technique remains unknown. In this study, we compared the early- and mid-term angiographic findings to elucidate its influence on the graft luminal diameter. We harvested 39 radial arteries either as a skeletonized (n = 18) or a non-skeletonized graft (n = 21) using an ultrasonic scalpel. We constructed a composite straight graft by combining a right internal thoracic artery and a radial artery. All the radial artery grafts were sequentially anastomosed to coronary arteries. We measured the diameters of the radial arteries before the operation, within 1 month and 1 year after the operation. At early postoperative period, graft diameter was significantly larger in skeletonized grafts. Graft diameter at the point before the first and the second anastomosis was similar in skeletonized grafts, although that was significantly smaller before the second anastomosis in non-skeletonized grafts. However, 1 year after the operation, the graft diameter was comparable and equally reduced after the first anastomosis in both groups. Skeletonization with an ultrasonic scalpel increases the luminal diameter of the radial artery graft at early postoperative period, which, however, reduces possibly as adaptation to graft flow 1 year after the operation.

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“…Early and late results of endto-end (tandem) and end-to-side (T configuration) composite IMA grafts were reported by Tector et al, [3], with similar outcomes for both. Composite tandem arterial grafts using the radial artery with inflow from the in situ right IMA have also been described with excellent short-term results [4,5]. This might seem to be an extravagant use of arterial conduit for a benefit not yet determined but it substantially increases the versatility of arterial grafting in coronary surgery.…”

Section: Introductionmentioning

confidence: 99%

Saphenous Vein to Internal Mammary Artery End-to-end Composite Grafts for Coronary Artery Bypass. Late Follow-up

Paterson

Thakkar

Denniss

2015

Heart, Lung and Circulation

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Remodeling of the radial artery anastomosed to the internal thoracic artery as a composite straight graft

Abstract: These results suggest that a composite straight radial and internal thoracic artery graft without a change in shear stress behaves like an extended arterial graft, with remodeling and vasoreactive capacity.

Cited by 6 publications

References 18 publications

Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

Change of luminal diameter of skeletonized and non-skeletonized radial artery graft at early and late postoperative period

Saphenous Vein to Internal Mammary Artery End-to-end Composite Grafts for Coronary Artery Bypass. Late Follow-up

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