Radial artery as a second conduit gains momentum: The RAPCO trial
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Abstract:
In coronary artery bypass grafting (CABG), the use of an internal mammary artery (IMA) to graft the left anterior descending coronary artery (LAD) improves survival and reduces the need for repeat revascularization. The other IMA, radial artery (RA), and saphenous vein (SV) have contested to complete the surgical revascularization. For that purpose, SV remains the most commonly used conduit despite current evidence in favor of arterial grafts. To determine which conduit is best for grafting the second most important coronary artery, Buxton and colleagues have recently published the long term results of their "Radial Artery Patency and Clinical Outcomes (RAPCO)" trial.Keywords:
Electrical conduit
Momentum (technical analysis)
Various comparison between siphon outlet conduit and straight outlet conduit,which are applied to a vertical installed axial pump,is completed and the following conclusions are obtained:①Under the condition of lower lift head,the hydraulic loss of the siphon outlet conduit is obviously less than that of the straight outlet conduit;②Manner of water current cut off for the siphon outlet conduit is very simple,reliable and economical,and that for the straight outlet conduit can not compare with it at all;③Under the condition of water levels to meet the requirement of siphon outlet conduit,to adopt the siphon outlet conduit is more reliable,more economical and more reasonable than to adopt the straight outlet conduit;④More attention should be highly paid to the selection for the type of the outlet conduit of a vertical installed axial pump system.
Electrical conduit
Siphon (mollusc)
Lift (data mining)
Hydraulic head
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Filled conduit is adopted as an example to analyze the finite elements of its structure by ANSYS program. The distributed law of the annular stress of conduit is analyzed and it is pointed out that the conduit top, bottom and side are the key conduit sections. Meanwhile, the results of ANSYS analysis are compared with those of structural mechanics and BEM method. At the same time, the deformation of backfilled earth around conduit is analyzed and compared with Anson Marston's theory.
Electrical conduit
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Background : It has been documented that the internal thoracic artery yields better long-term patency rates than saphenous vein grafts for coronary artery bypass grafting. The use of the radial artery for coronary artery bypass grafting is controversial. Radial artery has been used as the promising arterial grafts with the quality similar to the internal thoracic artery. The aim of this study was to evaluate the short-term patency rate of radial artery graft.Methods : From March to December 1999, radial artery graft was used in 15 patients (14 male and one female, mean age, 60.4 years) undergoing myocardial revascularization. Thirteen patients underwent angiographic studies in the early postoperative period (2-42 weeks after surgery).Results : Of 12 grafts studied, all were patent, however, 2 grafts (13%) showed string sign. The flow characteristics of the grafts were mainly graft dominant flow pattern.Conclusions : Our results suggest that with proper care, the radial artery may be used for coronary artery bypass grafting with good early results. Long-term follow-up and angiographic studies will be necessary to establish the merit of the radial artery as a graft for coronary artery operation.
Internal thoracic artery
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We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.
Gastroepiploic Artery
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Electrical conduit
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Radial artery increasingly is being used for coronary bypass grafting. Anatomic variantions of radial artery are rare but their clinical knowledge is important for surgeon performing radial artery harvest. We review the most often anatomic variations of radial artery on forearm and their influence to clinical practice.
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In recent years, the use of the radial artery as a coronary artery bypass graft has enjoyed a revival. This follows the initial disappointing results with the use of this blood vessel experienced by Carpentier and colleagues in the early 1970s. The improvement in the performance of the radial artery is believed to be caused by improved harvesting techniques and the use of vasodilator drugs. However, compared with other blood vessels used as bypass grafts, little is known about the vascular biology of this artery. The reactivity of the smooth muscle and protection offered by the vascular endothelium are known to be important factors that may determine the suitability of different arteries and veins to act as bypass conduits. The aim of this review is to examine how the properties of the vessel wall may contribute to the performance of the radial artery when used as a coronary artery bypass graft.
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The basic structural analysis of filled conduit was done with the ANSYS program. The basic process includes building of model, applying of boundary condition and loads, solving of model and analysis of result. The distributed law of annular stress of conduit was done. This paper pointed that the sections of conduit top, conduit bottom and conduit side were the key sections. The stress of conduit of ANSYS analysis method was compared with The Structural Method and BEM Method. At the same time, the deformation of backfilled earth around conduit was done and compared to the theory of Anson Marston.
Electrical conduit
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To observe the influence of endoscopic radial artery harvesting techniques on the prevalence of complications after coronary artery bypass grafting, and to assess the potential trauma to the radial artery through the histological changes.From August 2003 to June 2008, 87 patients undergoing CABG had radial artery harvested by endoscopic harvesting system. About 4 mm proximal and distal radial artery end segment of 10 patients undergoing endoscopic and conventional harvesting were examined with light and electro-microscope.The endoscopic harvest time was 42 to 98 min, with a mean of (57.6 +/- 17.3) min. The harvested conduit length was 15 to 20 cm, with a mean of (17.5 +/- 1.6) cm. Objective dorsal thenar numbness remained in 7 patients, none complained of forearm numbness at 3-month follow-up. The result of light and electro-microscope had no differences in the intima, media, or adventitia between endoscopically and conventionally obtained radial artery segments.The use of endoscopic radial artery harvesting in coronary artery bypass grafting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.
Adventitia
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