Gaudino Mario, Nasso Giuseppe, Canosa Carlo, Glieca Franco, Salica Andrea, Alessandrini Francesco, Possati Gianfederico
Department of Cardiac Surgery, Catholic University, Rome, Italy.
Ann Thorac Surg. 2005 Jun;79(6):1987-9. doi: 10.1016/j.athoracsur.2005.01.003.
No data are available on the different angiographic results and the in vivo vasoreactivity of radial artery (RA) grafts obtained from different parts of the conduit, although it is known that the distal segment of the artery has a more pronounced muscular component. This study was conceived to evaluate the angiographic patency and tendency to spasm of proximal versus distal RA grafts.
In 29 patients, at the time of surgical myocardial revascularization, the radial artery was divided into two separate conduits, so that these patients received a total of 58 radial grafts (29 from the proximal and 29 from the distal portion of the artery). All cases were submitted to midterm angiography and vasoactive challenges to verify angiographic patency and vasoreactive profile.
Radial artery patency rate was 28 of 29 for both groups. Nine cases of string sign were reported, all in the distal series (p = 0.001). The perfect patency rate of distal grafts was markedly lower than that of proximal grafts (19 of 29 versus 27 of 29; p = 0.02). Vasoactive challenges testified to a higher vasospastic attitude of distal grafts.
Radial artery grafts obtained from the distal portion of the artery have a higher vasospastic tendency, greater incidence of string sign, and lower midterm perfect patency rate than graft taken from the more proximal part of the artery. The proximal part of the RA should be preferred for use as a conduit for surgical myocardial revascularization.
尽管已知桡动脉（RA）远端段的肌性成分更为明显，但关于取自该血管不同部位的移植血管的不同血管造影结果及体内血管反应性，尚无相关数据。本研究旨在评估RA近端与远端移植血管的血管造影通畅率及痉挛倾向。
在29例患者进行外科心肌血运重建时，将桡动脉分为两根独立的血管，因此这些患者共接受了58根桡动脉移植血管（29根来自动脉近端，29根来自动脉远端）。所有病例均接受中期血管造影及血管活性刺激，以验证血管造影通畅情况及血管反应性特征。
两组的桡动脉通畅率均为29例中的28例。共报告9例线样征，均出现在远端组（p = 0.001）。远端移植血管的完美通畅率明显低于近端移植血管（29例中的19例对29例中的27例；p = 0.02）。血管活性刺激表明远端移植血管的血管痉挛倾向更高。
取自动脉远端的桡动脉移植血管比取自动脉近端的移植血管具有更高的血管痉挛倾向、更高的线样征发生率及更低的中期完美通畅率。在外科心肌血运重建中，应优先选用RA的近端作为血管。
