Tatoulis James
Royal Melbourne Hospital, Melbourne, Australia.
University of Melbourne, Melbourne, Australia.
Indian J Thorac Cardiovasc Surg. 2018 Dec;34(Suppl 3):234-244. doi: 10.1007/s12055-018-0694-3. Epub 2018 Sep 24.
It is now 25 years since the radial artery (RA) was reintroduced in coronary surgery. It has evolved into being a significant coronary artery bypass conduit and ranks third in usage after the internal thoracic artery (ITA) and saphenous vein grafts (SVG). Its advantages are that it can be readily and efficiently harvested, is of good length and appropriate size for coronary artery bypass graft (CABG) surgery, is robust and easy to handle, and remains free of atheroma, and there is minimal wound morbidity. The RA must be used judiciously with attention to spasm prophylaxis because of its muscular wall, and by avoiding competitive flow. Its patency is equivalent to the ITAs when placed to similar coronary territories and under similar conditions (stenosis, size, quality) and RA patencies are always superior to those of SVG in both observational and randomized studies-88-90% versus 50-60% at 10 years, and 80-87% versus 25-40% at 20 years. Its use and excellent patencies result in survival results equivalent to bilateral internal thoracic artery (BITA) grafting and always superior to left internal thoracic artery (LITA) +SVG. Typical radial artery multiarterial bypass grafting (RA-MABG) 10-year survivals are 80-90% versus 70-80% for LITA-SVG. In general, for every 100 patients undergoing CABG, 10 more patients will be alive at 10 years post-operatively. The RA also is important in achieving total arterial revascularization, and several reports indicate a further survival advantage for patients having three arterial grafts over two. The RAs are especially useful in diabetic, morbidly obese patients, those with conduit shortage, and leg pathology, and in coronary reoperations. Although the RA has equivalent patencies to the right internal thoracic artery (RITA), it is much more versatile. RAs that have been instrumented by angiography or percutaneous coronary intervention should be avoided. The radial artery has proved to be an excellent arterial conduit, is equivalent to but more versatile than the RITA, and is always superior to SVG. Its use should be part of every coronary surgeon's skill set.
桡动脉（RA）重新应用于冠状动脉手术至今已有25年。它已发展成为一种重要的冠状动脉旁路移植管道，在使用频率上仅次于胸廓内动脉（ITA）和大隐静脉移植血管（SVG），位居第三。其优点包括易于且高效获取，长度合适、大小适宜用于冠状动脉旁路移植术（CABG），坚韧且易于操作，无动脉粥样硬化，伤口并发症极少。由于其肌性管壁，桡动脉必须谨慎使用，注意预防痉挛，并避免竞争性血流。当置于相似的冠状动脉区域且在相似条件下（狭窄程度、血管大小、血管质量）时，其通畅率与胸廓内动脉相当，并且在观察性研究和随机研究中，桡动脉的通畅率始终优于大隐静脉移植血管——10年时分别为88% - 90%和50% - 60%，20年时分别为80% - 87%和25% - 40%。其应用及出色的通畅率所带来的生存结果等同于双侧胸廓内动脉（BITA）移植，且始终优于左胸廓内动脉（LITA）+大隐静脉移植血管。典型的桡动脉多支动脉旁路移植术（RA - MABG）10年生存率为80% - 90%，而LITA - SVG为70% - 80%。一般而言，每100例接受CABG的患者中，术后10年时会多10例存活。桡动脉对于实现完全动脉血运重建也很重要，几份报告表明，接受三支动脉移植的患者比接受两支动脉移植的患者有进一步的生存优势。桡动脉在糖尿病患者、病态肥胖患者、血管移植材料短缺患者、腿部有病变的患者以及再次冠状动脉手术中尤其有用。尽管桡动脉的通畅率与右胸廓内动脉（RITA）相当，但它的用途更为广泛。应避免使用已进行血管造影或经皮冠状动脉介入操作的桡动脉。桡动脉已被证明是一种出色的动脉移植管道，等同于RITA但用途更广泛，且始终优于大隐静脉移植血管。其应用应成为每位冠状动脉外科医生技能的一部分。
