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Myocardial revascularization using the radial artery : Surgical technique and early results

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

General Surgery

Advisors

Hallibian, Antoine, Balbaa, Yahya, Swilam, Muhammad

Authors

Abdel-Azhim, Anas Muhammad

Accessioned

2017-03-30 06:23:34

Available

2017-04-26 07:58:25

type

M.Sc. Thesis

Abstract

Background: the high incidence of late obstruction of venous bypass graft combined with the proven advantage of arterial revascularization stimulated a search for alternative conduit for CABG. The use of radial artery (RA), condemned as a bypass graft more than 20 years ago, has been revived with encouraging early and midterm results. Patients and Methods: in this study, we report part of the experience of Kasr Alaini’s Cardiothoracic Surgery Department with the use of radial artery in myocardial revascularization, emphasizing the important details in the harvesting technique and perioperative care. Between January 2004 and March 2005, 50 patients with coronary artery disease underwent surgical myocardial revascularization using the RA as one of the bypass conduits. The patients consisted of 40 males (80%) and 10 females (20%) with an average age of 52.5 years (range 40-65 years). To prevent RA spasm, all patients received calcium channel blockers both intra-operatively and postoperatively. The RA was harvested in a pedicle including its satellite veins. Target vessels for RA grafting were: obtuse marginal branches (51.4%), diagonal branches (20%), PDA (18.5%). Patients were followed-up during their hospital stay. All RA grafts were used as composite grafts with the LIMA. Results: 157 distal anastomoses were constructed (3.14 anastomosis/patient), 70 of these (44.5%) were done using RA grafts. In 36% of patients RA was used sequentially. Only one of the study patient died (2%), 1 patient (2%) developed postoperative MI and 2 patients (4%) showed evidence of postoperative ischaemia, but none in an area revascularized by a RA graft. Mean CK-MB level was 13.2 ± 11.6 IU/L. 2 patients (4%) needed IABP support while 2 patients (4%) were re-explored for bleeding. 1 patient (2%) developed acute renal failure while 1 patient (2%) developed sternal wound infection. Temporary parasthesia developed in 18 patients (36%) with no incidence of ischaemic or functional complications in the hand. Conclusion: the radial artery has several advantages over other conduits. It can be used safely to achieve total arterial revascularization or in cases of unavailable other conduits with encouraging early results. Its use does not seem to increase complexity and morbidity associated with CABG.

Issued

1 Jan 2006

Details

Type

Thesis

Created At

28 Jan 2023