Long-term (5- to 20-year) patency of the radial artery for coronary bypass grafting Paul Achouh, MD, Redha Boutekadjirt, MD, Daniel Toledano, MD, Nadjib.

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Presentation transcript:

Long-term (5- to 20-year) patency of the radial artery for coronary bypass grafting Paul Achouh, MD, Redha Boutekadjirt, MD, Daniel Toledano, MD, Nadjib Hammoudi, MD, Jean-Yves Pagny, MD, Pascal Goube, MD, Khaled Ould Isselmou, MD, Bernard Lancelin, MD, Régis Fouquet, MD, Christophe Acar, MD The Journal of Thoracic and Cardiovascular Surgery Volume 140, Issue 1, Pages 73-79.e2 (July 2010) DOI: 10.1016/j.jtcvs.2009.09.032 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 CT angiography scan at 9 years. A, Volume rendering showing a radial artery-to-obtuse marginal conduit with a left ITA to LAD graft. B, Maximum-intensity projection with curved multiplanar reformatted image of the radial artery conduit. C, Cross-sectional imaging demonstrating full graft patency. Open anastomosis (arrow) to the target. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Radial artery-to-diagonal controlled by conventional angiogram at 11 years (A) and CT at 13 years (B) (volume rendering). The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Competitive flow resulting in string-like involution of the distal segment of a radial artery graft sequentially anastomosed to the first and second obtuse marginal at 8 years: A, Circumflex coronary artery free from significant stenosis providing unrestricted flow to the second obtuse marginal, whereas the first obtuse marginal is hardly visible. B, Radial artery supplying the first obtuse marginal with string-like involution of its distal segment and no opacification of the second obtuse marginal. RA, Radial artery; OM, obtuse marginal. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Radial artery to obtuse marginal at 16 years. B, Same patient: severe atheromatous graft disease resulting in moderate stenosis of a saphenous vein conduit. In this patient, an additional vein graft was occluded. C, Other patient controlled at 16 years: CT scan demonstrating extensive calcification of the vein graft wall. In this case, the radial artery graft was occluded. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Implantation sites of coronary grafts Implantation sites of coronary grafts. RCA, Right coronary artery; LAD, left anterior descending; LITA, left internal thoracic artery; RITA, right internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

A, Stenosis (arrow) of the distal anastomosis of a radial artery graft to right coronary artery at 6 years. B, Result after stent implantation (arrow). The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

A, B, Radial artery grafts to diagonal and right coronary artery at 9 years in the same patient. C, Two radial artery grafts at 10 years: radial artery-to-diagonal branch (black arrow) proximally anastomosed to the aorto-to-obtuse marginal graft (white arrow). The Journal of Thoracic and Cardiovascular Surgery 2010 140, 73-79.e2DOI: (10.1016/j.jtcvs.2009.09.032) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions