Radial Artery the Second Best Conduit, our 10 years Experience.

Background:
Although Radial artery (RA) grafts exhibit a significantly better patency rate in midterm to long term follow up compare to saphenous vein grafts, recent data suggest that the RA is used in less than 6% of all coronary artery bypass grafting (CABG) procedure.

Methods:
Between 2006 and 2016, 241 consecutive Radial graft angiograms for postoperative cardiac symptoms were evaluated by two independent observers. Angiographic outcomes were divided into groups as (1) patent(<70% stenosis), (2) severe disease (≥70% stenosis) (3) string sign), or (4) total occlusion. Patency was examined by coronary territory, stenosis severity of the target vessels and grafts configuration free graft/T-graft and the number of distal sequential anastomosis.

Results:
A total of 2870 patients had a radial artery graft as part of CABG procedure. 380 distal radial anastomosis were examined; a range of 1-102 months post operatively. 177 anastomosis were grafted the right coronary system (distal RCA, PDA, PLB) , 203 to non-LAD left coronary system. 78.5% (189) as free graft and 21.5% (52) as a "T-graft". The numbers of sequential anastomosis in ascending order from 1 to 4 were 54.7 %( 132 patients), 34% (82), 10% (24) and 1.25 %( 3) respectively. No correlation was found between patient`s comorbidities and graft failure. Patency rate was significantly worse for target vessels with stenosis of less than 70%, and as the number of sequential anastomosis was higher (t=6.03,df=239,p<0.001). The best patency rate (88%) was for single free graft.

Conclusions:
Long term angiographic patency rate of RA graft is excellent for target vessels with significant stenosis (>70%). The risk for graft failure is increased as the number of sequential anastomosis is higher.