Radial Artery Coronary Bypass

The coronary artery bypass graft (CABG) surgery is the treatment of choice for severe left main and multivessel coronary artery disease. Both arterial and venous graft combinations are commonly used in CABG. Left internal mammary graft is still the preferred conduit because of the better long-term survival rates than other bypass conduits. Saphenous venous grafts (SVG), compared to arterial grafts, have a shorter overall life and have an increased tendency to degenerate and become occluded after an ischemic event. During the first year, SVG graft occlusion can occur in 10 to 15% cases, and 50% of them have significant or complete occlusion by ten years. Because of the poor long term outcomes associated with SVG, other arterial conduits, including the right internal thoracic artery, right gastroepiploic artery, right inferior epigastric artery, and radial artery, came into consideration. The use of bilateral internal mammary graft has been discouraged because of its association with increased sternal infection. The radial artery graft is easy to harvest and can be bypassed to reach the major coronary arteries; it has now gained popularity as the preferred option after the left internal mammary artery. Carpentier and his colleagues in 1973 first used the radial artery as an arterial conduit. However, within a few years, its use was abandoned because of the high rate of occlusion. Acar and colleagues reintroduced it in 1992 after discovering patent radial graft on an angiogram performed in a patient 18 years post CABG, which was previously thought to be occluded. With modification in surgical technique and utilization of antispasmodic agents, the radial artery graft patency rate is more than 90% at both one year and five years. This article will review the utility of the radial artery in CABG.