When harvested for coronary artery bypass graft surgery, does a skeletonized or pedicled radial artery improve conduit patency?

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether skeletonization of the radial artery (RA) improves conduit patency in coronary artery bypass grafting (CABG). Altogether 15 papers were found using the reported search, of which four papers represented the best evidence to answer the clinical question. Two papers compared patency rates between skeletonized and pedicled radial arteries. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We acknowledge that evidence is limited in this area of cardiac surgery. When assessing the skeletonized RA, three studies provided patency data one year after CABG. No patency data were available five years after CABG. Only two papers were comparative studies (skeletonized conduits vs. pedicled conduits). Despite the above, short- and medium-term patency rates of skeletonized conduits are excellent. In the two comparative studies, patency of skeletonized vessels was superior to the pedicled conduits. Patency was assessed with the use of angiography and rates exceeded 95% in all four studies. Overall patency rates were 100% within 18 days, 98.3% within three months, 97.6% at a mean of approximately 1 year, and 100% at 4 years in one study. From these studies, we can conclude that the patency rates of pedicled conduits are excellent, however, our study suggests that skeletonization may offer the radial conduit some patency benefit when compared to the pedicled technique. The remaining two non-comparative studies support the above conclusion.