Introduction
The first use of the RA as conduit for coronary artery bypass grafting is dated back in 1973 when Carpentier and colleagues published a case series of 30 patients1; the authors explored the RA potential due to the larger diameter, ease of dissection and generally more suitability for suturing. Ten months after the operation all the graft were opened, however they warned against early optimism because it needed to be ‘ascertained whether the arterial conduits were threatened by the same modifications as those observed in the venous grafts’2. Later on, in fact, the authors advised RA use to be discontinued because of a 30% incidence of graft occlusion.
Shortly after, other Authors also reported high rates of spasm and early occlusion and eventually the RA was abandoned for some times3.
Out of serendipity, almost 20 years later, a patient in whom postoperative angiography showed total occlusion was restudied and surprisingly the RA was fully patent, most importantly, with no evidences of atherosclerotic disease. Three other patients were re-studied, with similar angiographic results. These findings attracted newer attention of the potential use of RA as alternative graft for coronary surgery. Hence, Carpentier restarted the RA use, this time using CB, during and after the operation2 and in 1992, published a paper titled: ‘Revival of the radial artery for coronary artery bypass grafting’, where significant improved patency was reported4.
It was suggested that the ‘key’ for preserving RA patency perhaps was the use of CB since the very early start of the harvesting and the prescription as chronic antispastic agents. The concern of spasm with the RA use is indeed related to its unique histologic structures that significantly differ from all the other conduits routinely used for CABG.