Yes, I do. In my experience, radial artery is a much better conduit than the saphenous vein in the long run. It is also a good option when you are operating on obese patients in means of wound healing; i.e. forearm incision is less complicated than long leg incision. It has many other well known advantages.
We use it in young patients but just if we can avoid completely to use SV,
Absolutely! in > 90% of multi vessel coronary artery disease since 1997.
Will present on this topic as part of total arterial revascularisation at the King Fahad Cardiac Centre, Riyadh at 0730 Grand Rounds 7 April 2015.
Radial artery is gaining more popularity as the second best conduit after B ITA, better patency than saphenous , . Todays In kuwait where i moved, we use the endoscopically harvested radial artery with satisfactory results , minimal incision at the wrest, and lesser sensory complications. The quality of endoscopically harvested radials are great with Storz and ligasure, and very satisfactory with Vasoview provided : do not insuflate the port balloon and Minimize manipulation wit th C_ring ,. There is an eductional learning curve ( usually first 10_15 cases) for staff customized with endoscopy.
Indeed, the RA is gainig a bit more popularity again and we do still use it quite common, especially in younger patients requiring "full arterial revascularization". However, it should be respected, as the current evidence shows, that RA should be considered as the 3rd arterial graft, after LIMA an RIMA, not as a second! Basically, in almost all patients you can do a complete revascularization with BIMA. Additionally, also according to evidence, the RA should be placed on high-grade stenosed or occluded target and ideally proximally anastomosed in the aorta.
. we have used radial artery extensivelly in cabg , with ours and others experience , now it is restrict to patients with severe stenosis greater than 75% and good run of
Yes, for yong age patients, with good target, significant stenosis, usually on the OM site, this is after LIMA, and RIMA, using endoscopic harvestation, for total arterial revascularization
Dr Khaled, >>> regarding String sign>>>>so long we do coronary cath only for patients who raise a suspicion of PO recurrent ischemia, It is a limited number and can not give clear answer from our material, but we expect that few grafts will occlude, or go spasm., we are very strict to apply radial graft on targets with critical stenosis and good run off, we also strict to postoperative vasodilators and early antiplatelet beside avoiding manipulation of the graft during harvest, >>hoping to share in organized study soon
Why must you ask this question? The tone and tenor of your phrasing of the question suggests that RA grafting is hara kiri !
We do RA graft as a routine in all cases irrespective of age, unless contrindicated - Allen positive, heavily diseased or cor stenosis not critical. Infact at times even Bilateral RA.
Sure ,despite that it is exposed to spasm but gentile manibulation during harvesting and preperation decrease that and keeping the patient on ca ch blocker dramaticaly decrease the risk of spasm
i still believe that RA is superior to LSV but we all sure that it is not alternative to ITA
http://www.annalscts.com/article/view/2419/3285
http://www.annalscts.com/article/view/2419/3285
incidence of use of radial graft has came down but still is a good graft if properly used.
Dear prof. Khaled Alebrahim. In our department the tendency to radialis is significantly reduced during the last years after the use of no touch vengraft. Our experience shows that it is as good as arterial revascularisation and our patients are often very aged 75-85. We still mean that radialis is a good alternative.
Sincerely yours,
Dear Colleague:
It is obvious to everyone the importance of using coronary arterial grafts, that is very well documented in medical literature.
The use of the radial artery in our time has its very specific recommendations that this also published in cardiology Guides.
Do not forget that the world today tends to full arterial revascularization.
Brotherly
Dr. Nizahel Estévez Álvarez
the best arterial total revascularizatión is with two mamary artery. Tector technique
I use the radial artery only in reoperation cases.
We use a lot of Radias and have very good results. Total Arterial Revascularization for 90% of patients. Radial is the choice after LIMA and RIMA. We have seen a few spasms post op but I think still much superior to SVGs.
In Copenhagen University Hospital we do use radials, LIMA and RIMA in young low/intermidiate-risk patients. We harvest radialis sometimes open and other times video assisted/ scopic. By administering peroperative nitrate infusion and post operative per oral nitrates/calcium antagonist spasm is rare.
Sincerely,
Khalil Ahmad, Copenhagen University Hospital
We use RA in >85% of patients since 1997. This leads to total arterial revascularisation at a higher rate. We have found a survival advantage for use of total arterial revascularisation over any use of SVG.
There is no clinical evidence for the use of vasodilators with radial artery use; indeed 100% of my patients receiving RA have a low dose of noradrenaline infusion (norepinephrine).
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