Twenty-Year Data Show No Negative Impact of Radial Artery Harvest on Blood Flow of CABG Patients

Long-term follow-up of patients who have undergone CABG surgery with radial artery grafts instead of saphenous vein grafts (SVGs) offers reassurance that forearm blood flow is preserved, with no increased risk of ulnar atheroma, according to Australian researchers who have been practicing the radial artery harvest technique for over 20 years.

The findings show that harvesting primarily from the left radial artery “does not impair the blood flow to the forearm or hand at rest or with exercise and does not predispose the remaining ulnar artery to any greater risk of developing atherosclerosis,” write Alistair G. Royse, MBBS, MD (Royal Melbourne Hospital, Australia), and colleagues in a letter published online October 8, 2018, ahead of print in the Journal of the American College of Cardiology.

Among the 86 patients treated 12 to 22 years ago, brachial artery flow at rest was 238 ± 112 mL/min on the harvested side versus 249 ± 128 mL/min on the nonharvested side (P = 0.123). Similarly, after exercise brachial flow was 918 ± 411 mL/min on the harvested side versus 963 ± 434 mL/min on the nonharvested side (P = 0.114). Additionally, no patients reported pain with rest or exercise.

In an email, Royse said he has been using the radial-graft technique since 1994, adding that since mid-1996 his center has performed radial harvest for CABG in about 85% of patients. The new data from the long-term follow-up, he said, remain consistent with those of early follow-up that was conducted on more than 2,000 of their patients in 1999. Despite concern about the potential for ischemia of the hand, Royse said “to our knowledge the only two cases we have ever had of any measurable ischemic event related to [radial artery] harvest was in this early experience; both patients having a collagen-vascular disorder.” Although functional assessment of the arm was not performed in the long-term follow-up, Royse noted that when it was performed in early follow up there was “no significant impact of the harvest” on strength or sensation.

While 95% of the world continues to use at least one SVG in CABG, Royse said he has used it in approximately 0.5% of his cases in the last 22 years.

“We feel therefore that our long experience of [using the radial artery] should convince others to consider that there are morbidity benefits from using this conduit in preference to SVG,” he observed. “Moreover, there are also mortality benefits in terms of long-term survival.” In fact, in a paper published online recently in the European Journal of Cardiothoracic Surgery, Royse and colleagues analyzed compared survival out to 12.5 years according to number of SVG grafts CABG patients received versus avoidance of SVG with total arterial revascularization. 

“What we found was worse survival if even one single SVG was used,” Royse noted. “This negative survival effect was magnified if more than one SVG was used and each of these additional analyses were independently propensity-score-matched examinations.”