Muhammad Afsheen Iqbal, Khuda Baksh Sheikh, Farhan Akhtar Majeed, Azhar Rasheed, Syed Afzal Ahmad.
Radial artery as a conduit for Coronary Artery Bypass Grafting Surgery: early experience at AFIC/NIHD.
Pak J Cardiol Jan ;15(2):82-7.

Background: The long-term patency of vein grafts in the coronary circulation has been poor. By contrast, the left internal thoracic artery (LITA) graft to left anterior descending coronary artery (LAD) has been associated with excellent patency and good clinical results. The revival of radial artery (RA) as a graft has offered another source of arterial conduit in addition to the use of right internal thoracic artery (RITA). We evaluated our early experience with the use of RA as a conduit for coronary artery bypass grafting (CABG) surgery to establish its safety and efficacy. Methods: we studied 606 consecutive patients from January 2003 to December 2003 who underwent CABG surgery at our institute. Radial artery was used as a conduit `in 214 patients. Data was collected prospectively. In the radial artery group, the age range was 27 - 72 years, mean age 49.5 years. 136 (64%) of the patients had diabetes, only 7 (3.27%) patients were females. 8 (3.73%) patients had left ventricular ejection fraction of less than 30%, 146 (68.22%) patients had EF of 30-45% and rest were with good left ventricular function. 23 (10.74%) patients were classified as unstable/urgent. The conduits included were 206 left internal thoracic arteries, 26 right internal thoracic arteries and 214 radial arteries and 170 were vein grafts. Average number of grafts per patient was 2.87. Top ends of the free arterial grafts as well as all the vein grafts were anastamosed directly to the ascending aorta. Patients were followed up to 6 weeks, 24 weeks and then 6 monthly thereafter. Results: Complications included intra operative or post operative myocardial infarction in 6 (2.8%) patients, sternal wound infection in 4 (1.86%) patients, reoperation for excessive bleeding 17 (7.94%) patients. 14 (6%) patients required intra aortic balloon pump support, 46 (21%) required inotropic support. The incidence of hand complication was 7% (15 patients). The overall mortality rate in radial artery group was not much different from the non-radial artery group of patients undergoing CABG surgery in our settings. Conclusions: Radial artery may be used as a conduit for coronary artery bypass grafting operation with confidence as regards its safety.

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