Abstract 135: Should We Use Radial Artery in Patients With Peripheral Vascular Disease Undergoing Myocardial Revascularization?

Objective: Bilateral Internal Mammary (IMA) grafting is associated with improved survival. However, many surgeons are reluctant to use this revascularization technique in patients with peripheral vascular disease (PVD) due to their short life expectancy and the potential increased risk of sternitis.. The composite T graft with radial artery attached end-to-side to the left IMA provides arterial revascularization without increased risk of sternitis. The purpose of this study is to compare early and long-term outcome of these two revascularization strategies, in patients with PVD. Methods: Between 1999 and 2008, 462 consecutive patients with PVD (340 bilateral IMA and 122 single IMA and radial artery) underwent arterial myocardial revascularization. Results: Occurrence of female sex (35.2% versus 20.9%, radial group versus bilateral IMA, respectively), patients older than 70 (86% versus 59.7%), diabetes (52.52% versus 36.5%), emergency operation (26.2% versus 16.2%) and COPD (23.8% versus 9.4%) was higher in the radial group. The radial group also had a higher logistic Euroscore (25.4 versus 16.49). On the other hand recent MI (22.6% versus 13.1%) was more prevalent in the bilateral IMA group. Operative mortality of the two groups was similar (8.2% versus 6.5% for the radial and bilateral IMA, respectively). Occurrence of sternal infection was also similar (3.3% versus 0.9%). Median follow-up was 7.8 years. Kaplan Meier 10 year survival (47.1% versus 56.7%,), as well as Cox adjusted survival (p= 0.741) of the two groups were similar. Conclusion: In patients with PVD long-term outcome of arterial revascularization with left IMA and radial artery is similar to that of bilateral IMA. Therefore we recommend the use of single IMA and radial artery if double IMA's cannot be used safely.