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Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular Surgery Sheik Hamdam Bin Rashid Al Maktoum Distinguished Chair Cleveland Clinic Lerner College of Medicine

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Page 1: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Artery Grafting When to do it

( when to not do it )

Joseph F. Sabik, MDChairman and Professor of Surgery

Department of Thoracic and Cardiovascular Surgery

Sheik Hamdam Bin Rashid Al Maktoum Distinguished Chair

Cleveland Clinic Lerner College of Medicine

Page 2: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular
Page 3: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial ArteryAdvantages

• Relative large size• Few wound complications• Easy to work with• Prepare simultaneously with ITA• Long

Page 4: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Artery Disadvantages

• Sclerosis in diabetics• Damage by radial arterial lines• Ulnar flow may be insufficient• ? Patency

- Coronary Artery

- Competitive Flow

Page 5: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular
Page 6: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Study

Patients 190Intervention Radial artery graftingSetting Single center Time period 1996 to 2002F/U 6 yearsEndpoint Angiographic graft

patency

Page 7: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

100

90

80

70

60

500 12 24 36 72

Months after CABG

%

Zacharias, et. al., Circ, 2004

Graft PatencyITA, Radial, SVG

Vein (588)

Radial (242)

LITA (398)

48 60

Page 8: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular
Page 9: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Study

Patients 109Intervention Radial artery grafting

Composite “T” graft from ITA

Setting Single center Time period 1993 to 2001Mean F/U 27.1 monthsEndpoint Angiographic patency

Page 10: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Artery Patency Coronary Artery

100

80

60

40

20

00 12 24 36 48

Time (months)

RCA

LAD

Cx

%

Maniar et al: JTCS 2002

Page 11: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Artery PatencyProximal Coronary Stenosis

100

80

60

40

20

00 12 24 36 48

Time (months)

<70%

90-100%

%

Maniar et al: JTCS 2002

71-89%

Page 12: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular
Page 13: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Study

Patients 68 Intervention Radial artery grafting

Aortic proximalSetting Single center Time period 1993 to 1998Mean F/U 59 +/- 6.5 mthsEndpoint 5 year angiographic

patency

Page 14: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Grafts PatencyTarget-Vessel Stenosis

Occluded

String

Patient with irregularities

Perfectly patent

100

80

60

40

20

0

RAGrafts

(%)

50-60 70-80 80-90 >90

Target vessels stenosis (%)Possati et al: JTCS 1998

Page 15: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Artery Patency Critically Stenosed Left Coronaries

100

80

60

40

20

00 12 24 36 48

Time (months)

p=0.19

ITA (n=144)

%

Maniar et al: JTCS 2002

RA (n=43)

Page 16: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Radial Artery Patency Moderately Stenosed RCA

100

80

60

40

20

00 12 24 36 48

Time (months)

p<0.001

ITA (n=144)

%

Maniar et al: JTCS 2002

RA (n=30)

Page 17: Radial Artery Grafting When to do it ( when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular

Summary

• Target Vessel and Target vessel stenosis (competitive flow) important predictors of radial artery patency

• Best when used to graft severely stenotic left sided coronary arteries

• Worst when used to graft moderately stenosed right sided coronary arteries


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