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 Surgery
Sheik Hamdam Bin Rashid Al Maktoum Distinguished Chair
Cleveland Clinic Lerner College of Medicine

3. Radial Artery Advantages
Relative large size
Few wound complications
Easy to work with
Prepare simultaneously with ITA
Long

4. Radial Artery Disadvantages
Sclerosis in diabetics
Damage by radial arterial lines
Ulnar flow may be insufficient
? Patency
Coronary Artery
Competitive Flow

6. Study Patients 190 Intervention Radial artery grafting
Setting Single center Time period to 2002
F/U 6 years
Endpoint Angiographic graft patency 6

7. Graft Patency ITA, Radial, SVG
100 90
LITA (398) 80 % 70
Radial (242) 60
Vein (588) 50 12 24 36 48 60 72
Months after CABG
Zacharias, et. al., Circ, 2004

9. Study Patients 109 Intervention Radial artery grafting
Composite “T” graft from ITA
Setting Single center Time period to 2001
Mean F/U months
Endpoint Angiographic patency 9

10. Radial Artery Patency Coronary Artery
100
LAD 80 Cx 60 % 40
RCA 20 12 24 36 48
Time (months)
Maniar et al: JTCS 2002

11. Radial Artery Patency Proximal Coronary Stenosis
100
90-100% 80 60 %
71-89% 40
<70% 20 12 24 36 48
Time (months)
Maniar et al: JTCS 2002

13. Study Patients 68 Intervention Radial artery grafting Aortic proximal
Setting Single center Time period to 1998
Mean F/U 59 +/- 6.5 mths
Endpoint 5 year angiographic patency 13

14. Radial Grafts Patency Target-Vessel Stenosis
100
Occluded
String
Patient with irregularities
Perfectly patent 80 60 RA
Grafts
(%) 40 20
50-60
70-80
80-90
>90
Target vessels stenosis (%)
Possati et al: JTCS 1998

15. Radial Artery Patency Critically Stenosed Left Coronaries
100
ITA (n=144) 80
RA (n=43) 60 % 40 20
p=0.19 12 24 36 48
Time (months)
Maniar et al: JTCS 2002

16. Radial Artery Patency Moderately Stenosed RCA
100
ITA (n=144) 80 60 % 40
RA (n=30) 20
p<0.001 12 24 36 48
Time (months)
Maniar et al: JTCS 2002

17. 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