Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Angiographic Results of Radial Artery Grafts that are Used for Myocardial Revascularization

관상동맥 우회술 후 혈관조영술을 이용한 요골동맥의 개통률 분석

  • Yie, Kil-Soo (Department of Thoracic and Cardiovascular Surgery, Kangwon National University College of Medicine) ;
  • Oh, Sam-Sae (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital Sejong Heart Institute) ;
  • Kim, Jae-Hyun (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital Sejong Heart Institute) ;
  • Shinn, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine) ;
  • Kim, Soo-Cheol (Department of Thoracic and Cardiovascular Surgery, Kyung Hee University School of Medicine) ;
  • Seo, Hong-Joo (Department of Thoracic and Cardiovascular Surgery, Chosun University College of Medicine) ;
  • Na, Chan-Young (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital Sejong Heart Institute)
  • 이길수 (강원대학교 의과대학 흉부외과학교실) ;
  • 오삼세 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김재현 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 신성호 (한양대학교 의과대학 흉부외과학교실) ;
  • 김수철 (경희대학교 의과대학 흉부외과학교실) ;
  • 서홍주 (조선대학교 의과대학 흉부외과학교실) ;
  • 나찬영 (부천세종병원 흉부외과, 세종심장연구소)
  • Published : 2007.08.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The radial artery is gaining widespread acceptance as complementary arterial conduits for surgical myocardial revascularization, but there have been limited reports about its angiographic patency compared with that of internal thoracic artery or saphenous vein. We tried to evaluate angiographic patency of radial artery graft and to compare that of radial artery and other gratis with retrospective manner. Material and Method: From January 2001 to Jure 2006, totally 132 patients (male 92, female 40) who underwent coronary artery bypass graft using radial artery were re-admitted to our hospital for follow up angiographic examination. Mean age was 58.2+8.87 and mean follow up duration was 32 month ($2{\sim}110$ month). Off pump and on pump bypass surgery were performed 74 and 58 patients respectively. Along with radial artery, left internal thoracic arteries were used in 57 cases, concomitant left internal thoracic artery and saphenous veins were used in 47 cases and bilateral internal thoracic arteries were used in 20 cases. Result: Totally 412 distal anastomosis were performed and 376 anastomosis remained patent (91.2%). Left internal thoracic artery showed the most excellent patency in all of the conduits (98.5%). Radial artery graft patency was 90.8% (169/186). There was no statistical difference of the patency by conduit between on-pump and off-pump group. But radial artery showed more higher patency rate (98/110, 89%) in the severe stenotic lesion that preoperatively revealed more than 90% stenosis than in the lesser severe (<90%) stenotic lesion (60/76, 78%)(p < 0.005). Radial artery conduit represented the worst result when it was grafted in the right coronary system. But when it was positioned in the left heart especially diagonal or obtuse marginal area, patency was comparable with left internal thoracic artery. Conclusion: Radial artery graft showed good midterm patency when it was used in the severe stenotic lesion more than 90% and left coronary system. But great notice should be taken when it is grafted in the right coronary system or less severe stenotic lesion.

배경: 관상동맥 우회술에서 요골동맥 이식편의 사용이 증가하는 추세이나 혈관조영술을 이용한 요골동맥의 개통률 분석은 내흉동맥이나 복재정맥에 비해 적다. 대상 및 방법: 요골동맥을 이용한 관상동맥 우회술 후 2001년 1월부터 2006년 6월 사이에 재입원하여 혈관조영술을 시행받은 132명의 환자를 대상으로 하였다. 남자 92명, 여자 40명이었으며 수술 후 평균 32개월($2{\sim}110$개월)에 혈관조영술을 시행하였다. 수술 전 관상동맥 병소의 분포는 1혈관 질환이 7명, 2혈관 질환이 38명, 3혈관 질환이 87명이었으며 좌 주관상동맥 질환 46명이 포함되어 있었다. 인공심폐기를 사용한 경우(on-pump)가 58명, 인공심페기를 사용하지 않은 경우(off-pump)가 74명이었다. 결과: 관상동맥 조영술 결과 이식혈관의 평균 개통률은 91.2% (376/412)였으며 on pump군과 off pump군 사이의 개통률에 대한 통계학적 차이는 없었다(p=0.125). 수술 전 관상동맥 협착의 정도에 따른 요골동맥의 개통은 90% 이상의 협착이 있던 110개소 중 완전 개통을 보인 곳이 98개소(89%), 폐쇄된 경우가 8개소(7.3%)였으며, 90% 이하의 협착이 있던 76개소의 경우는 완전 개통이 60개소(78.9%), 폐쇄된 경우가 9개소(11.8%)로 나타나 수술 전 관상동맥에 90% 이상 협착이 있었던 군이 90% 미만의 협착이 있었던 군보다 높은 경향을 보였다(p=0.057). 폐쇄된 요골동맥 이식편의 관상동맥 문합 부위는 좌전하행지가 7군데 중1개소(14.2%), 대각지가 40군데 중 1개소(2.5%), 회선지가 96군데 중 6개소(6.2%), 우 관상동맥이 43군데 중 9개소(20.9%)로 우 관상동맥의 개통률이 가장 저조하였다(p=0.027). 요골동맥 근위부 문합방법에 따른 요골동맥이식편의 개통률은 3군간에 차이가 없었다(p=0.078). 결론: 요골동맥은 관상동맥 우회술에서 중기 혈관 조영술 상 만족할 만한 이식편이라 생각하지만 우 관상동맥에 이식하거나, 90% 이하의 관상동맥 협착에 이식시 개통률이 저조하였다. 인공심폐기의 사용 유무나 근위부 문합방법에 따른 개통률의 차이는 없었다.

Keywords

References

  1. Carpentier A, Guermonprez JL, Delocher A, et al. The aortocoronary radial artery bypass graft - a technique avoiding pathological changes in graft. Ann Thorac Surg 1973;16:11-21 https://doi.org/10.1016/S0003-4975(10)65808-0
  2. Acar C, Jebra VA, Portoghese M, et al. Revial of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992;54:652-60 https://doi.org/10.1016/0003-4975(92)91007-V
  3. Mussa S, Guzik TJ, Black E, Dipp MA, Channon KM, Taggart DP. Comparative efficacies and durations of action of phenoxybenzamine, verapamil/nitroglycerin solution, and papaverine as topical antispasmodics for radial artery coronary bypass grafting. J Thorac Cardiovasc Surg 2003;126:1798-805 https://doi.org/10.1016/S0022-5223(03)00943-7
  4. Acar C, Ramsheyi A, Pagny JY, et al. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 1998;116:981-9 https://doi.org/10.1016/S0022-5223(98)70050-9
  5. Possati G, Gaudino M, Alessandrini F, et al. Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. J Thorac Cardiovasc Surg 1998;116:1015-21 https://doi.org/10.1016/S0022-5223(98)70054-6
  6. Iaco AL, Teodori G, Di Giammarco G, et al. Radial artery for myocardial revascularization: long-term clinical and angiographic results. Ann Thorac Surg 2001;72:464-8 https://doi.org/10.1016/S0003-4975(01)02758-8
  7. Tatoulis J, Royse AG, Buxton BF, et al. The radial artery in coronary surgery: a 5-year experience-clinical and angiographic results. Ann Thorac Surg 2002;143:143-7;discussion 147-8
  8. Possati G, Gaudino M, Prati F, et al. Long-term results of the radial artery used for myocardial revascularization. Circulation 2003;108:1350-4 https://doi.org/10.1161/01.CIR.0000093723.57673.9F
  9. Amano A, Takahashi A, Hirose H. et al. Skeletonized radial artery grafting: improved angiographic results. Ann Thorac Surg 2002;73:1880-7
  10. Ronan JW, Perry LA, Barner HB, Sundt TM 3rd. Radial artery harvest: comparison of ultrasonic dissection with standard technique. Ann Thorac Surg 2000;69:113-4 https://doi.org/10.1016/S0003-4975(99)01193-5
  11. Rukosujew A, Reichelt R, Fabricius AM, et al. Skeletonization versus pedicle preparation of the radial artery with and without the ultrasonic scalpel. Ann Thorac Surg 2004;77:120-5 https://doi.org/10.1016/S0003-4975(03)01488-7
  12. Cikirikcioglu M, Yasa M, Kerry Z, et al. The effects of the harmonic scalpel on the vasoreactivity and endothelial integrity of the radial artery: a comparison of two different techniques. J Thorac Cardiovasc Surg 2001;122:624-6 https://doi.org/10.1067/mtc.2001.115690
  13. Casula RP, Kumar P, Ashrafian H, Athanasiou T. Evolving techniques for endoscopic radial artery harvesting. Cardiovasc Surg 2003;11: 425-7 https://doi.org/10.1016/S0967-2109(03)00099-1
  14. Connolly MW, Torrillo LD, Stauder MJ, et al. Endoscopic radial artery harvesting: results of first 300 patients. Ann Thorac Surg 2002;74:502-6 https://doi.org/10.1016/S0003-4975(02)03717-7
  15. Kulik A, Rubens FD, Gunning D, Bourke ME, Mesana TG, Ruel M. Radial artery graft treatment with pheno-xybenzamine is clinically safe and may reduce perioperative myocardial injury. Ann Thorac Surg 2007;83:502-9 https://doi.org/10.1016/j.athoracsur.2006.09.089
  16. Endo M, Nishida H, Tomizawa Y, Kasanuki H. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation 2001;104:2164-70 https://doi.org/10.1161/hc4301.098283
  17. Dion R, Glineur D, Derouck D, et al. Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting. Eur J Cardiothorac Surg 2000;17:407-14 https://doi.org/10.1016/S1010-7940(00)00370-5
  18. Lytle BW, Blackstone EH, Loop FD, et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 1999;117:855-72 https://doi.org/10.1016/S0022-5223(99)70365-X
  19. Maniar HS, Barner HB, Bailey MS, et. al. Radial artery patency: are aortocoronary conduits superior to composite grafting? Ann. Thorac Surg 2003;76:1498-504 https://doi.org/10.1016/S0003-4975(03)00758-6
  20. Na CY, Oh SS, Kim SC, et al. Cabrol technique application in off-pump coronary artery bypass grafting using radial artery. Korean J Thorac Cardiovasc Surg 2003;36:630-32