The radial artery (RA) is a versatile bypass conduit that is being used with increasing frequency. It is a suitable conduit for multiple arterial grafting during coronary artery bypass surgery (CABG). Meta-analyses have shown long-term survival benefits with the use of multiple arterial bypass grafts, emphasizing the importance of this technique, especially in young patients, who benefit most from improved long-term patency.
Although the right internal thoracic artery (RITA) is a natural option as a second arterial conduit, it is used uncommonly due to its inherent limitations, such as increased harvesting time, limited length, and the increased risk of deep sternal wound infection in higher-risk patients (for example those with diabetes, chronic pulmonary disease, obesity, and corticosteroid use). The RA avoids the issues of sternal healing while providing adequate length to bypass any target. Evidence of improved long-term patency compared to saphenous vein grafts is abundant. RA patency rates of 90% at 10 years and > 80% at 20 years are reported.
The RA can be harvested using open or endoscopic harvesting techniques with excellent outcomes. Both techniques result in conduits of similar quality with no differences in patency or survival. Both techniques have low rates of infection (< 1%) and neurological complications. Our preference is open harvesting, which allows for the use of a pedicled technique. This minimizes the manipulation of the artery itself and decreases the risk of spasm and intimal damage.