Technical Aspects of the Use of the Radial Artery in Coronary Artery Bypass Surgery

Abstract

Background. The radial artery has been used for coronary artery bypass surgery for more than 25 years. The recent confirmation of the clinical benefits associated with the use of the artery is likely to drive a new interest toward this conduit in the next few years.Methods. A group of surgeons with extensive experience in the systematic use of the radial artery summarize here the key technical aspects of the use of the conduit for coronary bypass operations.Results. Preoperative evaluation of the ulnar collateral circulation and attention to the characteristics of the target vessel are keys for the successful use of the radial artery. Open or endoscopic harvesting can be used,

The radial artery: An important component of multiarterial coronary surgery and considerations for its optimal harvest

“…6 Index finger plethysmography/oximetry combined with MAT adds a further level of certainty. 7 Further, duplex ultrasound (DU) is useful in complementing the MAT 8 and in determining RA diameter, calcification, atheroma, or prior damage (Figure 3). We avoid an RA with a distal internal luminal diameter <2 mm because of potential inadequate flow.…”

“…Verapamil is the best of these to be used in a topical/local milieu and is best combined with NTG (previously discussed). 7,11,12 Milrinone. Another powerful local and systemic vasodilator with a half-life of 2 hours.…”

“…It is best used with verapamil. 7,11,13 However, phenoxybenzamine is poorly soluble and not universally available. Other vasodilators.…”

Commentary: Radial artery tips from Melbourne: We stand on the shoulder of giants

“…We preserve the RA in buffered verapamil/nitroglycerine or papaverine in an asanguineous bath. 9 Once prepared for anastomosis, the RA is usually used as a free graft with an aortocoronary proximal anastomosis. The composite Y configuration can increase the number of distal coronary anastomoses but carries a greater risk of flow maldistribution and failure due to competitive flow.…”

“…Popularized by the author of this expert review, the "Baby Y" graft is a superb technical solution when the coronary anatomy is not suitable for a sequential anastomosis. 9 As MAG emerges as the superior revascularization strategy, the coronary surgeon will need to become increasingly comfortable with the RA. While there are a number of preand intraoperative considerations, when used in the right setting the RA offers superior long-term patency and outcomes.…”