Transradial angiography may deleteriously affect patency of radial artery grafts

Editor—The review by Archbold et al comprehensively outlines the many advantages of radial access.¹ However, it does not touch on the potential harmful effects that such an approach may have on the patency of radial artery grafts when patients later have coronary artery bypass grafts.

Current interest in the use of radial arteries as the second conduit of choice after the internal mammary artery is rising. The negative effect of radial access on the patency rates of radial arteries used in coronary artery bypass grafting may be especially important in younger patients where greater longevity of the graft (above that of saphenous vein grafts) can be expected to bring long term benefit. Kamiya et al showed, in 22 patients who underwent transradial angiography before coronary artery bypass grafting, that angiographic patency of radial artery grafts was lower at one month after the procedure (77% v 90%, P = 0.017).²

Furthermore, an ultrasonographic study by Nagai et al showed that, after transradial access for coronary angiography or angioplasty, 22% of radial arteries were diffusely stenosed, and 5% had no detectable flow at late (mean 95 days) follow up.³ We have observed that most surgeons are hesitant to use the radial artery as a graft within a few days of transradial access due to presumed intimal damage.

We think that consideration should be given to the appropriateness of the transradial approach in acute patients in whom the likelihood of urgent coronary artery bypass grafting is high, in younger patients, and in patients in whom there may be a shortage of conduits.