Radial Artery Use in Coronary Artery Bypass Grafting

Evidence Supporting Radial Artery Use

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines give a Class 1, Level B-R recommendation for using the radial artery in preference to saphenous vein conduits for grafting the second most important non-LAD vessel 3, 4
Several randomized trials and meta-analyses have demonstrated better mid- and long-term patency rates for the radial artery compared to saphenous vein grafts 1, 3
A pooled analysis of 6 randomized trials showed improved clinical outcomes regarding adverse cardiac events at 5 and 10 years after surgery when the radial artery was used instead of saphenous vein grafts 1, 3

Patients who benefit most from radial artery grafts include those under 75 years of age, women, and patients with preserved renal function 1, 3
Avoid using the radial artery in patients with chronic kidney disease who have a high likelihood of progression to hemodialysis 1, 4

Before harvesting, objectively assess palmar arch completeness and ulnar compensation, using the arm with the best ulnar compensation 1, 3
Avoid using the radial artery after transradial catheterization 1, 3
Avoid bilateral percutaneous or surgical radial artery procedures in patients with coronary artery disease to preserve the artery for future use 1, 3

Use oral calcium channel blockers for the first postoperative year after radial artery grafting to prevent vasospasm 1, 3

While the LIMA remains the gold standard conduit for the LAD (Class 1, Level B-NR recommendation), the radial artery has emerged as the preferred second arterial conduit 1, 3, 4
Bilateral internal mammary artery (BIMA) grafting can be beneficial in appropriate patients (Class 2a, Level B-NR recommendation), but is technically more challenging and has higher risk of sternal wound complications 1, 3, 5
The right gastroepiploic artery can be used to graft right coronary artery target vessels with subocclusive stenosis if the operator is experienced with this artery 1, 3

Despite strong evidence supporting radial artery use, there remains significant variation in practice, with some centers using it in only 9% of CABG procedures 5
The extensive use of arterial conduits (>2) instead of saphenous vein grafts for multivessel CABG may provide additional late mortality benefits 1, 3