Defining the role of the radial artery.

Our experience with the radial artery in 172 patients from October 1993 through February 1995 has been favorable, with no early or late deaths in a group of selected patients. In 35 of the first 72 patients, the proximal anastomosis of the radial artery was to the aorta, and in all other patients it was to the left internal thoracic artery (ITA). In the first 72 patients, there were 43 right ITA grafts, 13 gastroepiploic artery grafts, and 6 saphenous vein grafts (3.57 distals per patient). In the last 100 patients, only 2 other conduits (saphenous vein) were used (in addition to left ITA and radial artery) for 3.46 distals per patient, with complete revascularization achieved in all patients requiring it. Five perioperative infarctions, 2 reoperations for bleeding, 6 intra-aortic balloon pumps, 3 instances of myocardial hypoperfusion (1 requiring a balloon pump), and 1 mediastinal wound infection were noted. Four patients required catheterization for recurrent symptoms, and all had patent radial arteries (1 from the aorta and 3 from the left ITA), but 1 ITA was stenotic at the distal anastomosis. One patient was older, with preoperative heart failure that recurred, and 2 were younger, with diffuse coronary disease. This early favorable clinical experience, when combined with the early patency data of others, suggests that continued use of this conduit is appropriate with close observation of outcome.