Skeletonization of the Radial Artery with the Ultrasonic Scalpel: Clinical and Angiographic Results


  • Hitoshi Hirose
  • Atsushi Amano
  • Akihito Takahashi
  • Syuichirou Takanashi



Background: To improve the patency rate of the radial artery graft, we have been using a skeletonized harvesting technique since September 1, 2001. Our early reports confirmed better graft patency of the skeletonized radial graft than the conventional pedicled graft. However, its midterm results were unknown. We present our recent experience and follow-up results of radial artery grafting using the skeletonized harvesting technique.

Methods: Between September 1, 2001, and July 31, 2002, 391 patients underwent isolated coronary artery bypass surgery in our hospital group, excluding minimally invasive direct coronary bypass procedures via small thoracotomy or T-grafting. Among them, skeletonized radial grafting was performed in 246 patients (182 men and 64 women; mean age, 66.2 ± 9.5 years). Follow-up is to be completed by December 31, 2003. Perioperative, early angiographic, and follow-up results were analyzed.

Results: There were 1 hospital death and 5 incidences of postoperative myocardial infarction. None of these occurrences were related to radial artery bypass. Early angiography revealed that the stenosis-free graft patency rate of radial artery anastomoses (291/303 cases, 96.0%) was not significantly different from the patency rates of surgeries involving the use of other conduits (left internal mammary artery, 95.1%; right internal mammary artery, 93.8%; gastroepiploic artery, 93.1%; and saphenous vein, 98.2%). Follow-up was completed for all hospital survivors with a mean follow-up time of 1.4 ± 0.3 years. There were no cardiac deaths and 5 cardiac events, giving a cardiac event-free rate of 97.5%. Conclusion: In our limited follow-up, cardiac events have been well controlled. Midterm follow-up angiographic study is necessary to confirm our clinical outcome data.


Amano A, Takahashi A, Takanashi S, Hirose H. 2002. Skeletonized radial artery grafting: improved angiographic results. Ann Thorac Surg 73:1880-7.nBizzarri F, Frati G. 2002. Harvesting of the radial artery: skeletonization versus pedicled technique. Ann Thorac Surg 73:1359-60.nBuxton B, Fuller J, Gaer J, et al. 1966. The radial artery as bypass graft. Curr Opin Cardiol 11:591-8.nBuxton B, Windsor M, Komeda M, Gear J, Fuller J, Liu J. 1997. How good is the radial artery as a bypass graft? Coron Artery Dis 8:225-33.nBuxton BF, Fuller JA, Tatoulis J. 1998. Evolution of complete arterial grafting: for coronary artery disease. Tex Heart Inst J 25:17-23.nCalafiore AM, Di Giammarco G, Teodori G, et al. 1995. Radial artery and inferior epigastric artery in composite grafts: improved midterm angiographic results. Ann Thorac Surg 60:517-24.nCarpentier A, Guermonprez JL, Deloche A, Frechette C, Du Bost C. 1973. The aorta-to-coronary radial artery bypass graft: a technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111-21.nAcar C, Jebara VA, Portoghese M, et al. 1992. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 54:652-60.nAcar C, Ramsheyi A, Pagny JY, et al. 1998. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 116:981-9.nAmano A, Hirose H, Takahashi A, Nagano N. 2001. Off-pump coronary arterial bypass: mid-term results. Jpn J Thorac Cardiovasc Surg 49:67-78.nDietl CA, Benoit CH. 1995. Radial artery graft for coronary revascularization: technical considerations. Ann Thorac Surg 60:102-9.nFitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. 1996. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and re-operation in 1,388 patients during 25 years. J Am Coll Cardiol 28:616-26.nGarg UC, Hassid A. 1989. Nitric oxide-generating vasodilators and 8-bromo-cyclic guanosine monophosphate inhibit mitogenesis and proliferation of cultured rat vascular smooth muscle cells. J Clin Invest 83:1774-7.nLemma M, Gelpi G, Mangini A, et al. 2001. Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery. Ann Thorac Surg 71:1969-73.nMills NL, Everson CT. 1995. Vein graft failure. Curr Opin Cardiol 10:562-8. Moran SV, Baeza R, Guarda E, et al. 2001. Predictors of radial artery patency for coronary artery bypass. Ann Thorac Surg 72:1552-6.nParolari A, Rubini P, Alamanni F, et al. 2000. The radial artery: which place in coronary operation? Ann Thorac Surg 69:1288-94.nPsacioglu H, Atay Y, Cetindag B, Saribulbul O, Buket S, Hamulu A. 1998. Easy harvesting of radial artery with ultrasonically activated scalpel. Ann Thorac Surg 65:984-5.nRonan JW, Perry LA, Barner HB, Sundt TM. 2000. Radial artery harvest: comparison of ultrasonic dissection with standard technique. Ann Thorac Surg 69:113-4.nTaggart DP, Mathur MN, Ahmad I. 2001. Skeletonization of the radial artery: advantages over the pedicled technique. Ann Thorac Surg 72: 298-9.nvan Son JA, Smedts F, Vincent JG, van Lier HJ, Kubat K. 1990. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 99:703-7.nWeinschelbaum EE, Gabe ED, Macchia A, Smimmo R, Suarez LD. 1997. Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg 114:911-6.nWeinschelbaum EE, Macchia A, Caramutti VM, et al. 2000. Myocardial revascularization with radial and mammary arteries: initial and mid-term results. Ann Thorac Surg 70:1378-83.n



How to Cite

Hirose, H., Amano, A., Takahashi, A., & Takanashi, S. (2005). Skeletonization of the Radial Artery with the Ultrasonic Scalpel: Clinical and Angiographic Results. The Heart Surgery Forum, 6(3), E42-E47.