Due to the histological configuration of the vessel wall, the radial artery is prone to spasm as a result of handling or harvesting. Therefore, certain degrees of arterial wall spasm are unpreventable, even with appropriate pharmacologic treatment, while using the radial artery as a bypass graft in CABG. Consequently, the radial artery is only reluctantly used compared to saphenous vein grafts in CABG. In our clinical experience, the radial artery, if harvested carefully, has proved to be an excellent bypass graft. This investigation was undertaken to study the differences in blood flow measured directly after extracorporeal circulation in radial artery grafts and venous grafts. Both grafts were compared to the left internal mammarian artery anastomosed to the LAD. Methods: Between January 1998 and December 1999, 198 patients who were undergoing coronary artery revascularization with two grafts were retrospectively investigated. In all patients, the left internal mammarian artery (LIMA) was anastomosed to the left anterior descending branch (LAD). For the second graft, either the saphenous vein or the radial artery was used. Proximal anstomoses were performed as end-to-side into the ascending aorta. Patients were divided into four groups: Group 1: n = 79 IMA-LAD, vein to the circumflex artery; Group 2: n = 56 IMA-LAD, vein to the right coronary artery; Group 3: n = 34; IMA-LAD, radial artery to the circumflex artery; Group 4: n = 29 IMA-LAD, radial artery to the right coronary artery. Graft-flow measurements were performed using the transit-time method after extracorporeal circulation was terminated. The mean systolic, diastolic, and mean blood flow were measured, and the pulsatility index was calculated. Statistical analysis was performed using the of t-test analysis between the variables mean blood flow and pulsatility index. A p-value of < 0.05 was defined as statistically significant. Results: There were no statistically significant differences in mean blood flow or pulsatility index between radial artery and saphenous vein grafts to the right coronary artery and the circumflex artery, respectively. Also, there were no differences regarding vein grafts to the right coronary artery and to the circumflex artery, or regarding radial artery grafts to the two coronaries, respectively. In group 4, significantly lower blood flow to the LAD was found compared to group 1, and a significantly higher pulsatility index compared to groups 2 and 3. Conclusions: Radial artery grafts compared to saphenous vein grafts do not show significant differences early after operation in mean blood flow or pulsatility index. Further studies are needed to evaluate long-term performance of radial arteries as coronary bypass grafts and to compare the radial artery to the right mammarian artery and the standard saphenous vein graft.
Key words:
Transit-time doppler - Cardiovascular disease - Coronary disease - Coronary surgery - Radial artery - Revascularization
References
-
1
Carpentier A, Guermonpres J L, Deloche A, Frechette C, DuBost C.
The aorta-to-coronary artery bypass graft. A technique avoiding pathological changing in grafts.
Ann Thorac Surg.
1973;
16
(2)
111-121
-
2
Acar C, Jehara V A, Portoghese M. et al .
al. Revival of the radial artery for coronary artery bypass grafting.
Ann Thorac Surg.
1992;
54
(4)
652-660
-
3
Buxton B, Gaer J, Komeda M, Ruengsakulrach P. et al .
The road to complete arterial grafting for coronary artery disease.
Int J Cardiol.
1997;
62
(Suppl 1)
S65-S70
-
4
D’Ancona G, Karamanoukan H L, Ricci M. et al .
Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting.
Eur J Cardiothorac Surg.
2000;
17
(3)
287-293
-
5
Walpoth B H, Bosshard A, Kipfer B. et al .
Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement.
Eur J Cardiothorac Surg.
1998;
14
(Suppl 1)
576-581
-
6
Walpoth B H, Bosshard A, Genyk I. et al .
Transit-time measurement for detection of early graft failure during myocardial revascularization.
Ann Thorac Surg.
1998;
66
(3)
1097-1100
-
7
Fonger J D, Doty J R, Sussman M S. et al .
Lateral MIDCAB grafting via limited posterior thoracotomy.
Eur J Cardiothorac Surg.
1997;
12
(3)
399-405
-
8
Louagie Y A, Haxhe J P, Jamart J. et al .
Intraoperative assessment of coronary artery bypass grafts using a pulsed Doppler flowmeter.
Ann Thorac Surg.
1994;
58
(3)
742-749
-
9
Walpoth B H, Mohadjer A, Gersbach P. et al .
Intraoperative internal mammary artery transit-time flow measurements: comparative evaluation of two surgical pedicle preparation techniques.
Eur J Cardiothorac Surg.
1996;
10
(12)
1064-1070
-
10
Louagie Y A, Haxhe J P, Buche M. et al .
Intraoperative electromagnetic flowmeter measurements in coronary artery bypass grafts.
Ann Thorac Surg.
1994;
57
(2)
357-364
-
11
Barnea O, Santamore W P.
Intraoperative monitoring of IMA flow: what does it mean?.
Ann Thorac Surg.
1997;
63
(6 Suppl)
S 12-S 17
-
12
Lust R M, Zeri R S, Spence P A. et al .
Effect of chronic native flow competition on internal thoracic artery grafts.
Ann Thorac Surg.
1994;
57
(1)
45-50
-
13
O’Neill M , Wolf P D, O’Neill T K. et al .
A rationale for the use of sequential coronary artery bypass grafts.
J Thorac Cardiovasc Surg.
1981;
81
(5)
686-690
-
14
Voigtlander T, Dahm M, Kreitner K F. et al .
(Intraoperative flow measurement of coronary bypass grafts using the ultrasound transit time flowmeter).
Z Kardiol.
1999;
88
(10)
773-779
, German
-
15
Canver C C, Dame N A.
Ultrasonic assessment of thoracic artery graft flow in the revascularized heart.
Ann Thorac Surg.
1994;
58
(1)
135-138
-
16
Mills N L, Bringaze W L .
Preparation of the internal mammary graft. Which is the best method?.
J Thorac Cardiovasc Surg.
1989;
98
(1)
73-79
-
17
Matre K, Birkeland S, Hessevik I. et al .
Comparison of transit-time and Doppler ultrasound methods for measurement of flow in aortocoronary bypass grafts during cardiac surgery.
Thorac Cardiovasc Surg.
1994;
42
(3)
170-174
-
18
Canver C C, Cooler S D, Murray E L. et al .
Clinical importance of measuring coronary graft flows in the revascularized heart. Ultrasonic or electromagnetic?.
J Cardiovasc Surg (Torino).
1997;
38
(3)
211-215
-
19
Kreitner K F, Voigtlander T, Wittlinger T. et al .
(Flow quantification in coronary and bypass vessels with MR phase contrast technique).
Radiologe.
2000;
40
(2)
143-149
, German
-
20
Walpoth B H, Muller M F, Genyk I. et al .
Evaluation of coronary bypass flow with color-Doppler and magnetic resonance imaging techniques: comparison with intraoperative flow measurements.
Eur J Cardiothorac Surg.
1999;
15
(6)
795-802
-
21
Sturm J T, Snow N J, van Heeckeren D W. et al .
Coronary artery bypass grafts: increased flow in the early postoperative period.
Ann Thorac Surg.
1980;
29
(6)
534-538
-
22
Wendler O, Hennen B, Markwirth T. et al .
T grafts with the right internal thoracic artery to the left internal thoracic artery versus the left internal thoracic artery and radial artery: flow dynamics in the internal thoracic artery main stem.
J Thorac Cardiovasc Surg.
1999;
118
(5)
841-848
1 Presented as an oral presentation at the 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery, Lucerne, Switzerland, February 9-12, 2000
Jürgen EnnkerMD, PhD
Heart Institute Lahr/Baden
Hohbergweg 2
77933 Lahr
Phone: 07821/925-100
Fax: 07821/925-110
Email: jürgen.ennker@heart-lahr.com
