Abstract
Accumulating evidence supports multi-arterial over single arterial myocardial revascularization. Multi-arterial grafting results in equivalent perioperative but in superior long-term outcomes.The Radial Artery (RA) as the second arterial graft after the Left Internal Thoracic Artery (LITA) is the best and easiest way to achieve this providing spasm prophylaxis is used and competitive flow avoided.The RA is potentially available in >90% of patients, and can be used exactly as a Saphenous Vein Graft (SVG).Long, robust, wider than the Right ITA, easy to harvest and handle, versatile, can be used, singly or sequentially from the aorta or as Y or extension graft and can reach any target. Simultaneous harvest with the LITA is time efficient. Both RAs are potentially available.Short term RA patencies are excellent, >90% in observational studies and randomized trials (RCTs). Once deployed without technical problems, RAs stay patent forever, usually retaining perfect patency. 15-20 year patencies (including early failures) are 87%-90%, with fewer cardiac adverse events and superior survival in RCTsContraindications include poor ulnar collaterals (rare), severe calcification, diameter <2mm, collagen diseases, trauma, recent instrumentation, and potential haemodialysis.The RA can and should be used universally, and especially for obese patients, diabetics, those with pulmonary disease, peripheral vascular disease, females, elderly patients, in re-operations and conduit shortage,Wound infections are rare and early ambulation is facilitatedThe RA is the ideal second arterial graft especially for those embarking on multi-arterial grafting. More versatile than RITA. Its use does not exclude the RITA nor SVG.
Published Version
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