The use of the Radial Artery (RA) as a conduit in coronary artery bypass
grafting (CABG) has been steadily increasing since the early 1990’s and
based on the most recent data may well become the standard of care for
patients with multi-vessel coronary artery disease (CAD) requiring
multiple arterial grafts. The TRA approach for cardiac catherization has
also increased steadily in use by interventional cardiologists owing to
its reduction in bleeding and vascular complications when compared with
the femoral approach and is now considered the preferred arterial
access. However, prior use of transradial access (TRA) for cardiac
catherization is a contra-indication for the use of the RA for CABG
because of high rates of structural damage to the vascular wall and
potential for graft failure. In this issue of the Journal of Cardiac
Surgery Clarke et al. examine the RA of two patients who had TRA for
coronary angiography 8 and 12 years prior and note that both patients
had chronic injury with dissection and obstruction of the lumen
secondary to fibrosis suggesting that TRA causes long-term and
irreversible damage rendering them unsuitable as conduits for CABG.
Never again. Once used for cardiac catherization the radial artery cannot be used for CABG
