Interact CardioVasc Thorac Surg 2008;7:800. doi:10.1510/icvts.2007.172569A
© 2008 European Association of Cardio-Thoracic Surgery
eComment: Is the inner diameter of radial artery reliable for its suitability as a graft?
Efstratios Apostolakis,
Ioanna Koniari and
Dimitrios Dougeni
Cardiothoracic Surgery Department of University Hospital of Patras, 22500 Rion Patras, Greece
Non-harvestable radial artery. A bilateral problem?
According to your study [1], one of the contraindications for radial artery harvesting is its small inner proximal and distal diameter, smaller than 2 mm (Tables 2 and 3 of the above study). This consideration is arbitrary and undocumented. The inner instantaneous diameter of the radial artery is the result of a dynamic and sensitive process, depending on the instantaneous vascular tone respectively. Especially for muscular type arteries such as radial, the vascular tone is very variable. On the contrary, large arteries modify their blood flow by increasing or reducing their internal diameter. Such a flow-dependent dilatation represents a fundamental mechanism that opposes the equivalent neurogenic and myogenic mechanisms that are activated during exercise vasoconstriction; in order to maintain sheer stress within physiological levels [2].
Factors such as the environmental temperature, muscular exercise, postischemia hyperemia, levels of endogenous or exogenous catecholamines, aagonists, and heart failure result from time to time in a continuous variability of the radial diameter and wall thickness/diameter ratio.
Giannattasio et al. [3] demonstrated that congestive heart failure (CHF) is characterized by a reduction of the inner diameter of muscular arteries, which is proportionally related too the severity of the disease. In addition, Boutouyrie et al. [4] reported that the radial artery in hypertensive patients was not dilated but was with a thicker wall, compared to the normotensive population. Thus, the wall cross-sectional area and wall/lumen ratio were markedly increased in hypertensive patients, factors that indicated the normalization of circumferential wall stress.
In conclusion, in patients with coronary artery disease (CAD) and simultaneously left ventricular dysfunction, or with hypertension, the estimation of the inner diameter of the radial artery may lead to false rejection of radial artery suitability as a graft (‘false – unsuitable’).
 |
References
|
|---|
- Kohonen M, Teerenhovi O, Terho T, Laurikka J, Tarkka M. Non-harvestable radial artery. A bilateral problem? Interact CardioVasc Thorac Surg 2008;7:797–800.[Abstract/Free Full Text]
- Joannidis R, Haefeli W, Linder L, Richard V, Bakkali H, Thuillez C, Luescher T. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation 1995;91:1314–1319.[Abstract/Free Full Text]
- Giannattasio C, Achilli F, Failla M, Capra A, Vincenzi A, Valagussa F, Mancia G. Radial, carotid and aortic distesibility in congestive heart failure: effects of high-dose angiotensin-converting enzyme inhibitor of low-dose association with angiotensin type-1 receptor blockade. J Am Coll Cardiol 2002;39:1275–1282.[Abstract/Free Full Text]
- Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S. Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation 1999;100:1387–1393.[Abstract/Free Full Text]
Related Article
-
Non-harvestable radial artery. A bilateral problem?
- Mika Kohonen, Ossi Teerenhovi, Tiina Terho, Jari Laurikka, and Matti Tarkka
Interactive CardioVascular and Thoracic Surgery 2008 7: 797-800.
[Abstract]
[Full Text]
[PDF]
|
|
Top
References