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Does Clinical Profile Preclude Use of Radial Artery as a Conduit in Coronary Artery Bypass Grafting?

 Om Prakash Yadava, Vinod Sharma, Arvind Prakash, Bikram Kesharee Mohanty, Rekha Mishra,Vikas Ahlawat, and Anirban Kundu

Aims: Use of radial artery in coronary artery bypass grafting has been supported by the results of several histopathology and angiographic studies that have shown excellent short, medium and long term results. However the effect of coronary risk factors on its results may be of concern. This study was undertaken to correlate the association of major clinical risk factors with intimal hyperplasia and atherosclerosis in radial artery using preoperative doppler studies, intraoperative morphometry and postoperative histopathology (HP) and morphometry.

Methods and results: This was a prospective study involving 100 patients undergoing coronary artery bypass grafting surgery in whom radial artery was used as a conduit. The radial artery was assessed using preoperative doppler ultrasound studies, intraoperative morphometry and postoperative histopathology (HP) and morphometry. In our series hypertension (69%), diabetes mellitus (54%), tobacco usage (33%) and dyslipidaemia (10%) were dominant coronary risk factors. A correlation was sought to be established between these risk factors and presence of radial artery disease. Presence of diabetes did not correlate with radial artery disease (p=0.487). Although the prevalence of disease was higher in patients having hypertension, dyslipidaemia and history of smoking, the numbers were not statistically significant. (p=0.7085 for hypertension, p=0.248 for dyslipidaemia and p of 0.387 for smoking).

Conclusions: In view of the variable or no predictive value of these clinical risk factors, we conclude that radial artery should be used as a second arterial conduit after internal mammary artery in all patients undergoing coronary artery bypass grafting irrespective of clinical risk profile.