A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts.

In the past decade, the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a randomized trial in which we controlled for bias in the selection of patients and vessels. We enrolled 561 patients at 13 centers. The left internal thoracic artery was used to bypass the anterior circulation. The radial-artery graft was randomly assigned to bypass the major vessel in either the inferior (right coronary) territory or the lateral (circumflex) territory, with the saphenous-vein graft used for the opposing territory (control). The primary end point was graft occlusion, determined by angiography 8 to 12 months postoperatively. Angiography was performed at one year in 440 patients: 8.2 percent of radial-artery grafts and 13.6 percent of saphenous-vein grafts were completely occluded (P=0.009). Diffuse narrowing of the graft (the angiographic "string sign") was present in 7.0 percent of radial-artery grafts and only 0.9 percent of saphenous-vein grafts (P=0.001). The absence of severe native-vessel stenosis was associated with an increased risk of occlusion of the radial-artery graft and diffuse narrowing of the graft. Harvesting of the radial artery was well tolerated. Radial-artery grafts are associated with a lower rate of graft occlusion at one year than are saphenous-vein grafts. Because the patency of radial-artery grafts depends on the severity of native-vessel stenosis, such grafts should preferentially be used for target vessels with high-grade lesions.

Desai ND ，Cohen EA ，Naylor CD ，Fremes SE ，Radial Artery Patency Study Investigators ... -  《-》

Radial artery versus saphenous vein patency randomized trial: five-year angiographic follow-up.

Collins P ，Webb CM ，Chong CF ，Moat NE ，Radial Artery Versus Saphenous Vein Patency (RSVP) Trial Investigators ... -  《-》

Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts.

Khot UN ，Friedman DT ，Pettersson G ，Smedira NG ，Li J ，Ellis SG ... -  《-》

Contemporary coronary graft patency: 5-year observational data from a randomized trial of conduits.

Hayward PA ，Buxton BF 《-》

Impact of patient and target-vessel characteristics on arterial and venous bypass graft patency: insight from a randomized trial.

Desai ND ，Naylor CD ，Kiss A ，Cohen EA ，Feder-Elituv R ，Miwa S ，Radhakrishnan S ，Dubbin J ，Schwartz L ，Fremes SE ，Radial Artery Patency Study Investigators ... -  《-》