Radial Artery in CABG

Q: In which subset of patients should the radial artery graft be used cautiously in cardiac arterial bypass surgery (CABG)?

Answer: Renal disease patients who are at risk for requiring dialysis

More and more heart centers and surgeons are increasingly using radial artery graft for CABG. One of the reasons for using radial graft along with the internal mammary graft, mostly left (LIMA) is due to literature showing higher long-term patency with two arterial grafts.

Intensivists should be aware of the fact that immediately after CABG surgery, many of these patients may develop spasm of the graft. Use of prophylactic vasodilator agent, such as intravenous (IV) nitro or calcium channel blocker (CCB), may help to prevent this complication.

As expected adequate ulnar artery flow to prevent the loss of hand function should be performed prior to making decision about use of radial artery via Allen test.

Also, post surgery, patient may feel forearm numbness and tingling, but these symptoms usually resolve with any clinical significance.

Renal patients who are at risk of going on dialysis should ideally be not get radial artery harvesting as it limits the creation of arterio-venous fistula or graft on the ipsilateral arm.

#surgical-critical-care

#vascular surgery

References:

1. Gaudino M, Benedetto U, Fremes S, et al. Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. N Engl J Med 2018; 378:2069.

2. Maniar HS, Sundt TM, Barner HB, et al. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovasc Surg 2002; 123:45.

3. Iacò AL, Teodori G, Di Giammarco G, et al. Radial artery for myocardial revascularization: long-term clinical and angiographic results. Ann Thorac Surg 2001; 72:464.