Remodeling of the radial artery anastomosed to the internal thoracic artery as a composite straight graft

Operative procedure. All patients except one (G) with saphenous vein grafts (SVGs) sequentially anastomosed to the left anterior descending and obtuse marginal artery had left internal thoracic artery to left anterior descending artery grafts. A, Composite straight grafts are directed along the right side in patients with stenoses of posterodescending and posterolateral arteries (n = 11). B and C, Composite straight grafts are directed over the aorta in patients with stenoses of the posterolateral and obtuse marginal arteries or with diagonal and posterolateral or obtuse marginal arteries (n = 8). D, Sequential anastomosed SVGs in patients with stenoses of the diagonal and posterolateral arteries (n = 4). E, Sequential anastomosed SVGs in patients with stenoses of the obtuse marginal and posterolateral arteries and with stenoses of the 2 posterolateral arteries (n = 3 and 1). F, Sequential anastomosed SVGs in patients with stenoses of the posterodescending and posterolateral arteries (n = 11). G, Sequential anastomosed SVGs in patients with stenoses of the left anterior descending and obtuse marginal arteries (n = 1).

Sites of preoperative and postoperative measurements of each graft. A, Sites of postoperative angiographic measurements of the radial artery and internal thoracic artery. The diameters of the internal thoracic artery and radial artery were measured 10 mm proximal and 10 mm distal to the anastomosis, respectively. RAD₁ and RAD₂ values were measured 10 mm proximal to the anastomoses with native coronary arteries. ITAD, Diameter of the internal thoracic artery; RAD, diameter of the radial artery; RAD₁, diameter of the radial artery before the first anastomosis; RAD₂, diameter of the radial artery before the second anastomosis. B, Sites of postoperative angiographic measurements of the saphenous vein grafts sequentially anastomosed. SVGD₁ and SVGD₂ values were measured 10 mm proximal to the anastomoses with native coronary arteries. SVGD₁, Diameter of the saphenous vein graft before the first anastomosis; SVGD₂, diameter of the saphenous vein graft before the second anastomosis.

A, Angiogram of composite straight grafts and saphenous vein grafts (SVGs) 3 weeks after surgical intervention. Left, The difference in diameters between the radial arteries and right internal thoracic arteries before surgical intervention had disappeared 3 weeks after surgical intervention. Right, Sequentially anastomosed saphenous vein graft 3 weeks after surgical intervention. The arrow indicates the anastomosis of the radial artery to the right internal thoracic artery. RITA, Right internal thoracic artery; RA, radial artery; PD, posterior descending branch; PL, posterolateral branch; SVG, saphenous vein graft. B, Change in the diameters of the grafts with time. The preoperative diameters of the radial arteries were significantly different from those of the right internal thoracic arteries. The diameters of the radial arteries and internal thoracic arteries were almost the same 3 weeks and 1 year after surgical intervention. The specific comparisons also indicate significance. RA, Radial artery; RITA, right internal thoracic artery. ***Radial artery vs right internal thoracic artery: P < .0001. C, Change in the ratio of the internal thoracic artery to the radial artery diameter with time. The ratio of internal thoracic artery to radial artery diameter increased to almost 1 at 3 weeks and 1 year after surgical intervention. ITA, Internal thoracic artery; RA, radial artery. ***P < .001 compared with the preoperative ratio.

A, Change in the diameters of the radial arteries (RA) before the first and second anastomoses 3 weeks after surgical intervention. The radial arteries had changed their diameters before the first and second anastomoses with native coronary arteries 3 weeks after surgical intervention. RAD₁, Diameter of the radial artery before the first anastomosis; RAD₂, diameter of the radial artery before the second anastomosis. B, Change in the diameters of the radial arteries before the first and second anastomoses 1 year after surgical intervention. The radial arteries had changed their diameters before the first and the second anastomoses with native coronary arteries 1 year after surgical intervention. RAD₁, Diameter of the radial artery before the first anastomosis; RAD₂, diameter of the radial artery before the second anastomosis. C, Change in the diameters of the saphenous vein grafts before the first and second anastomoses 3 weeks after surgical intervention. The saphenous vein grafts had not changed their diameters before the first and second anastomoses with the native coronary arteries 3 weeks after surgical intervention. SVGD₁, Diameter of the saphenous vein graft before the first anastomosis; SVGD₂, diameter of the saphenous vein graft before the second anastomosis.