Zhang H, Wang Z W, Wu H B, Hu X P, Zhou Z, Xu P
Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, 430060, Wuhan, Hubei Province, China.
Herz. 2014 Jun;39(4):458-65. doi: 10.1007/s00059-013-3848-5. Epub 2013 Jun 21.
Coronary artery bypass grafting (CABG) is the best therapeutic option for multivessel coronary artery diseases. The internal thoracic artery is usually used for the left anterior descending coronary artery. However, it is still not clear what the best conduit is for non-left anterior descending coronary arteries. This research sought to assess the efficacy of the radial artery versus the saphenous vein in this context.
A systematic literature search was performed for randomized clinical trials (RCT) published in MEDLINE, EMBASE, and the Cochrane Library. RCTs reporting angiographic comparisons and clinical events of the radial artery versus the saphenous vein were included.
Six trials (1,860 participants, 1,188 radial artery grafts, 1,178 saphenous vein grafts) were included in this review. The radial artery was associated with a significantly lower incidence of graft failure (p < 0.05) and of repeat coronary operation (p < 0.05). There was no significant trend toward decreased cardiac death and myocardial infarction with the use of a radial artery (p > 0.05; p > 0.05). As determined by the GRADE method, the evidence quality was low for repeat operation and very low for other variables.
The radial artery can be weakly recommended as a selective conduit but cannot always be considered better than the saphenous vein.
冠状动脉旁路移植术（CABG）是多支冠状动脉疾病的最佳治疗选择。胸廓内动脉通常用于冠状动脉左前降支。然而，对于非左前降支冠状动脉，最佳的移植血管仍不明确。本研究旨在评估在此情况下桡动脉与大隐静脉的疗效。
对发表在MEDLINE、EMBASE和Cochrane图书馆的随机临床试验（RCT）进行系统文献检索。纳入报告桡动脉与大隐静脉血管造影比较和临床事件的RCT。
本综述纳入了6项试验（1860名参与者，1188例桡动脉移植，1178例大隐静脉移植）。桡动脉与移植失败发生率显著降低（p<0.05）和再次冠状动脉手术发生率显著降低（p<0.05）相关。使用桡动脉在心脏死亡和心肌梗死方面没有显著下降趋势（p>0.05；p>0.05）。根据GRADE方法确定，重复手术的证据质量低，其他变量的证据质量极低。
桡动脉可作为一种选择性移植血管被弱推荐，但不能总是被认为优于大隐静脉。
