Forearm Artery Not So Great for Heart Surgery

With cardiac bypass surgery, a blood vessel found elsewhere in the body is used to bypass the blocked arteries feeding the heart. Findings from a new study suggest that a vessel in the forearm called the radial artery may not be the best choice.

With cardiac bypass surgery, a blood vessel found elsewhere in the body is used to bypass the blocked arteries feeding the heart. Findings from a new study suggest that a vessel in the forearm called the radial artery may not be the best choice. This is because the radial artery is less likely than other “grafts” to remain open after surgery. On long-term follow-up, only about half of radial artery grafts are still open. In contrast, up to 90 percent of other graft types remain open. When a graft closes, patients often need to undergo heart surgery again. According to the new report, the best choice for cardiac bypass surgery was a blood vessel on the inside of the chest called the internal mammary artery (IMA). The next best choice was a vessel in the leg called the saphenous vein (SVG). The findings are reported in Circulation: Journal of the American Heart Association. “Most studies comparing radial artery grafts with SVG and IMA grafts have looked at outcomes within 1 year of surgery,” lead author Dr. Umesh N. Khot, from Indiana Heart Physicians in Beech Grove, told Reuters Health. “In that time frame, all three graft types tend to do well.” “Our study looked at patients a little bit farther out in time and it included patients who were returning with problems,” Khot noted. “The results suggest that radial artery grafts aren’t doing as well as we expected them to.” The findings are based on a study of 310 patients who underwent heart surgery at The Cleveland Clinic between 1996 and 2001. Because more than one blood vessel is typically bypassed with heart surgery, all of the patients had radial artery grafts as well as other types. Women appeared to be particularly poor candidates for radial artery grafts. At follow-up, just 39 percent of their grafts remained open compared with 56 percent of those in men. “The findings suggest that instead of having 100% enthusiasm for radial artery grafts, we need to pause for a moment and really question whether they’re doing what we’re claiming them to be doing,” Khot said. (SOURCE: Circulation: Reuters Health News: Anthony J. Brown, MD: May 2004.)