To optimize graft flow and graft patency of arterial graft, all arterial conduits including the internal mammary artery (since January 1999), radial artery (since September 1999) and gastroepiploic artery (since September 2002) have been harvested in skeletonized technique. Currently, in Japan, the “standard” technique of radial artery harvesting has been completely changed from pedicle harvesting technique (the artery, associated veins, adventitia, and surrounding fascia harvested as an en-block using an electrocautery) to skeletonized harvesting technique (removal of all adventitia from the main trunk of the radial artery using a ultrasonic scalpel). Here we report our experience of more than 500 cases of skeletonized radial artery grafting.
Between September, 1999 and April, 2004, isolated coronary artery bypass grafting (CABG) was performed in a total of 893 patients at Shin-Tokyo –Juntendo Hospital Group. Of these, 557 patients underwent skeletonized radial artery grafting, and their perioperative, early angiographic, and follow-up results were analyzed.
Study group was consisted of 417 male and 138 female with mean age of 66.2 ± 9.1, and preoperative EuroSCORE of 3.7 ± 2.7. The details of the perioperative data are shown in Table 1. No perioperative myocardial infarction, bleeding related to the radial artery graft or graft harvesting site complication was observed. Early angiography within 3 month after surgery was performed in 291 patients demonstrated radial artery anastomosis patency rate of 97.0% (458/472) and stenosis-free anastomosis patency rate of 92.8% (458/472). Distant angiography beyond 6 months after surgery performed in additional 37 patients, revealed stenosis-free anastomosis patency rate of 92.4% (61/66). Follow-up was completed all hospital survivors with a mean follow-up of 1.0 ± 0.5 years and found 3 patients (0.5%) developed radial artery related cardiac events.
The early clinical outcome and angiographical results of radial artery grafting using “new standard” skeletonized harvested technique were excellent and comparable to previous reports of those with “classical” pedicle harvesting technique.
This new standard skeletonization technique may replace the classical pedicle harvesting technique.
Hitoshi Hirose, None.