Topical Vasodilators for Preventing Radial Artery Spasm during Harvesting for Coronary Revascularization: Comparison of 4 Agents

Authors

  • Vedat Nisanoglu
  • Bektas Battaloglu
  • Bulent Ozgur
  • Tamer Eroglu
  • Nevzat Erdil

DOI:

https://doi.org/10.1532/HSF98.20061070

Abstract

Background. There is still controversy about which vasodilator solution is best for storing radial artery (RA) conduits prior to coronary artery bypass grafting. The aim of this pilot study was to investigate how 4 different topical vasodilators applied during RA harvesting affect blood flow with the vessel in situ.

Materials and Methods. The subjects were 85 patients who underwent RA harvesting in preparation for coronary artery bypass grafting. Each case was assigned to 1 of 5 groups (17 RAs each) that were treated with different solutions: normal saline (control), nitroglycerin, diltiazem, papaverine, and adenosine. Standard clinical concentrations were used. The RA was partially harvested (pedicle attached proximally) and flow rates and hemodynamic parameters (mean arterial pressure, heart rate, central venous pressure) were recorded at 2 time points: (1) pretreatment and (2) after 5 minutes of immersion in 60 mL of treatment solution. Results were compared within and between groups, and post-treatment-to-pretreatment ratios were calculated for each variable.

Results. There were no significant differences among the groups' mean pretreatment flow rates (P = .979) or mean posttreatment flow rates (P = .069). All except the diltiazem group showed a significant rise in mean flow rate from pretreatment to posttreatment. The mean posttreatment-to-pretreatment ratios for RA flow rate were 1.28 ± 0.39 in the saline group, 1.85 ± 0.72 in the nitroglycerin group, 1.31 ± 0.48 in the diltiazem group, 1.37 ± 0.64 in the papaverine group, and 1.23 ± 0.42 in the adenosine group. Only the mean flow ratio in the nitroglycerin group was significantly higher than that in the saline group (P = .003). The mean flow ratios in the other vasodilator groups were not statistically different from the flow ratio in the saline group.

Conclusions. These preliminary results indicate that topical application of nitroglycerin solution effectively prevents perioperative spasm of the RA in patients undergoing coronary artery bypass surgery. The authors recommend this solution for preparation and storage of RA grafts. Randomized controlled trials with power analysis will give more definitive information.

References

Acar C, Jebara VA, Portoghese M, et al. 1992. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 54:652-60.nAffleck DG, Barner HB, Bailey MS, et al. 2004. Flow dynamics of the internal thoracic and radial artery T-graft. Ann Thorac Surg 78:1290-4.nBarner HB. 1999. The continuing evolution of arterial conduits. Ann Thorac Surg 68:S1-8.nBond BR, Zellner JL, Dorman BH, et al. 2000. Differential effects of calcium channel antagonists in the amelioration of radial artery vasospasm. Ann Thorac Surg 69:1035-41.nCable DG, Caccitolo JA, Pearson PJ, et al. 1998. New approaches to prevention and treatment of radial artery graft vasospasm. Circulation 98:II15-22.nCable DG, Caccitolo JA, Pfeifer EA, et al. 1999. Endothelial regulation of vascular contraction in radial and internal mammary arteries. Ann Thorac Surg 67:1083-90.nCarpentier A, Guermonprez JL, Deloche A, Frechette C, DuBost C. 1973. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111-21.nChanda J, Brichkov I, Canver CC. 2000. Prevention of radial artery graft vasospasm after coronary bypass. Ann Thorac Surg 70:2070-4.nChanda J, Canver CC. 2001. Reversal of preexisting vasospasm in coronary artery conduits. Ann Thorac Surg 72:476-80.nChong WC, Ong PJ, Hayward C, Moat N, Collins P. 2001. Effects of storage solutions on in vitro vasoreactivity of radial artery conduits. J Thorac Cardiovasc Surg 122:470-5.nConant AR, Shackcloth MJ, Oo AY, Chester MR, Simpson AW, Dihmis WC. 2003. Phenoxybenzamine treatment is insufficient to prevent spasm in the radial artery: the effect of other vasodilators. J Thorac Cardiovasc Surg 126:448-54.nFisk RL, Brooks CH, Callaghan JC, Dvorkin J. 1976. Experience with the radial artery graft for coronary artery bypass. Ann Thorac Surg 21:513-8.nGabe ED, Figal JC, Wisner JN, Laguens R. 2001. Radial artery graft vasospasm. Eur J Cardiothorac Surg 19:102-4.nHe GW. 1998. Verapamil plus nitroglycerin solution maximally preserves endothelial function of the radial artery: comparison with papaverine solution. J Thorac Cardiovasc Surg 115:1321-7.nHe GW, Yang CQ. 1996. Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting. Ann Thorac Surg 61:610-4.nHe GW, Yang CQ. 1999. Comparison of the vasorelaxant effect of nitro-prusside and nitroglycerin in the human radial artery in vitro. Br J Clin Pharmacol 48:99-104.nLocker C, Mohr R, Paz Y, et al. 2002. Pretreatment with alpha-adrenergic blockers for prevention of radial artery spasm. Ann Thorac Surg 74:S1368-70.nLuscher TF, Diederich D, Siebenmann R, et al. 1988. Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 319:462-7.nMedina P, Segarra G, Martinez-Leon JB, et al. 2000. Relaxation induced by cGMP phosphodiesterase inhibitors sildenafil and zaprinast in human vessels. Ann Thorac Surg 70:1327-31.nShapira OM, Xu A, Vita JA, et al. 1999. Nitroglycerin is superior to diltiazem as a coronary bypass conduit vasodilator. J Thorac Cardiovasc Surg 117:906-11.nShapira OM, Alkon JD, Macron DS, et al. 2000. Nitroglycerin is preferable to diltiazem for prevention of coronary bypass conduit spasm. Ann Thorac Surg 70:883-9.nTanaka KA, Szlam F, Katori N, Tsuda A, Levy JH. 2004. In vitro effects of antihypertensive drugs on thromboxane agonist (U46619)-induced vaso-constriction in human internal mammary artery. Br J Anaesth 93:257-62.nTatoulis J, Jiang GC, Moffatt JD, Cocks TM. 1999. Storage of radial artery grafts in blood increases vessel reactivity to vasoconstrictors in vitro. Ann Thorac Surg 68:2191-5.nVelez DA, Morris CD, Muraki S, et al. 2001. Brief pretreatment of radial artery conduits with phenoxybenzamine prevents vasoconstriction long term. Ann Thorac Surg 72:1977-84.nZabeeda D, Medalion B, Jackobshvilli S, Ezra S, Schachner A, Cohen AJ. 2001. Comparison of systemic vasodilators: effects on flow in internal mammary and radial arteries. Ann Thorac Surg 71:138-41.n

Published

2006-08-07

How to Cite

Nisanoglu, V., Battaloglu, B., Ozgur, B., Eroglu, T., & Erdil, N. (2006). Topical Vasodilators for Preventing Radial Artery Spasm during Harvesting for Coronary Revascularization: Comparison of 4 Agents. The Heart Surgery Forum, 9(6), E807-E812. https://doi.org/10.1532/HSF98.20061070

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