A New Technique for Intraoperative Graft Angiography Utilizing the Radial Artery Stump

Abstract

Background: Angiographic visualization is the gold standard in evaluating the patency of newly constructed bypass grafts. With the growth of beating heart bypass grafting procedures, there is a need to confirm patency and document the success of the operative techniques.

Methods: We have developed a new technique for performing intraoperative graft angiography following off-pump coronary artery bypass grafting (OPCABG) when utilizing the left radial artery as a free graft. Once the radial artery is removed, the proximal radial artery stump is cannulated using a standard femoral introducer sheath passed over an appropriately sized guide wire. The introducer is secured by simple ligature and the arm remains abducted during the construction of the grafts. Prior to heparin reversal, standard coronary angiographic catheters are introduced through the sheath and intraoperative images of the grafts obtained.

Results: Transsternal OPCAB was performed in 7 patients using the left radial artery as a free graft followed by transradial artery completion angiography. A total of 18 grafts (2.5 per patient) were examined with an immediate patency rate of 100% and TIMI grade 3 flow in all grafts. Mean fluoroscopy time was 8.21 minutes. No angiographic or surgical complications occurred in this group.

Conclusions: Beating heart coronary bypass grafting is evolving as a new standard which competes with the traditional technique of cardiopulmonary bypass and elective cardiac arrest. With newer digital portable fluoroscopy systems, excellent imaging of newly constructed grafts can be obtained prior to completion of the procedure using a transradial approach. Verification of graft patency is the essential element in protecting the quality of surgical coronary artery reconstruction in the new era of beating heart surgery.