Preview

Grekov's Bulletin of Surgery

Advanced search

Functional state of coronary shunts from the radial artery in the presence of morphological changes in its wall

https://doi.org/10.24884/0042-4625-2023-182-2-38-45

Abstract

The OBJECTIVE of the research was to study the patency of coronary shunts from the radial artery in the presence of morphological changes in its wall in the period from 40 to 52 months after surgery.

METHODS AND MATERIALS. Fragments of 110 radial arteries taken from 103 patients for coronary artery bypass grafting in the period from 2018 to 2021 were subjected to histological examination. To assess the functional state of the shunts in the period from 40 to 52 months after surgery, computed tomography of the coronary arteries (CTCA) with contrast was performed in 66 patients.

RESULTS. Histological examination revealed such changes in the radial artery wall as edema of one layer of the artery or all three layers, proliferation of the subendothelial layer of the inner coat, intimal fibrosis, partial obstruction of the artery lumen by a massive accumulation of agglutinated erythrocytes, as well as occlusion of the radial artery. Occlusion of the shunt from the radial artery in the period of 41–42 months was detected in 2 patients who underwent computed tomography of the coronary arteries.

CONCLUSION. Statistical analysis of the obtained results revealed that the presence of such morphological changes in the radial artery wall as alteration, exudation and proliferation does not statistically significantly affect the timing of adequate functioning of the shunt.

About the Authors

S. M. Khokhlunov
Samara State Medical University; Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Khokhlunov Sergey M., Dr. of Sci. (Med.), Professor, Head of the Department of Cardiovascular Surgery of the Institute of Postgraduate Education; Cardiovascular Surgeon, the 4th Cardiac Surgery Department

Samara



D. V. Kuznetsov
Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Kuznetsov Dmitrii V., Cand. of Sci. (Med.), Cardiovascular Surgeon, Deputy Chief Physician for Surgical Work

Samara



A. A. Gevorgyan
Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Gevorgyan Arik A., Cardiovascular Surgeon, the 11th Cardiac Surgery Department, Head of the Department

Samara



K. M. Mikhailov
Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Mikhailov Kirill M., Cardiovascular Surgeon, the 11th Cardiac Surgery Department

43, Aerodromnaya str., Samara, 443070



I. F. Nefedova
Samara State Medical University

Nefedova Irina F., Chief Specialist of the Preclinical Research Department of the Research Institute “BioTech”

Samara



E. N. Nikolaeva
Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Nikolaeva Elena N., Pathologist, Pathoanatomical Department, Head of the Department

Samara



G. H. Taumova
Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Taumova Gulslu H., Radiologist, Radiology Department

Samara



O. V. Garbuz
Samara Regional Clinical Cardiology Dispensary named after V. P. Polyakov
Russian Federation

Garbuz Olga V., Radiologist, Radiology Departmen

Samara



M. M. Yokubov
Samara State Medical University
Russian Federation

Yokubov Mirolim Mirodil ugli, Resident of the Department of Cardiovascular Surgery of the Institute of Postgraduate Education

Samara



References

1. Neumann F. J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A. P. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization // Eur. Heart J. 2019;40:87–165. Doi: 10.1093/eurheartj/ehy394.

2. S´a M. P., Soares A. M., Lustosa P. C., Martins W. N., Browne F. et al. Meta-analysis of 5,674 patients treated with percutaneous coronary intervention and drug-eluting stents or coronary artery bypass graft surgery for unprotected left main coronary artery stenosis // Eur. J. Cardiothorac. Surg. 2013;43(1):73–80. Doi: 10.1093/ejcts/ezs204.

3. Schneider Yu. A., Krasikov A. V., Nemchenko E. V. Free arterial transplants in coronary artery surgery // Grekov’s Bulletin of Surgery. 2004; 2:107–112. (In Russ.).

4. Chikwe J., Sun E., Hannan E. L., Itagaki S., Lee T. et al. Outcomes of second arterial conduits in patients undergoing multivessel coronary artery bypass graft surgery // J. Am. Coll. Cardiol. 2019;74:2238–2248.

5. Locker C., Schaff H. V., Dearani J. A., Joyce L. D., Park S. J. et al. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease // Circulation. 2012;126:1023–1030.

6. Aboul-Hassan S. S., Marczak J., Stankowski T., Moskal L., Stanislawski R., et al. Impact of second arterial conduit on outcomes following coronary bypass grafting // Thorac. Cardiovasc. Surg. 2022;71(6):434–440. Doi: 10.1055/s-0042-1745805.

7. Schwann T. A., Hashim S. W., Badour S., Obeid M., Engoren M. et al. Equipoise between radial artery and right internal thoracic artery as the second arterial conduit in left internal thoracic artery-based coronary artery bypass graft surgery: a multi-institutional study // Eur. J. Cardiothorac. Surg. 2016;49:188–195.

8. ESC / EACTS Recommendations for 2018 Myocardial Revascularization. URL: https://russjcardiol.elpub.ru/jour/article/viewFile/3510/2661 (accessed: 17.02.2021). (In Russ.).

9. Buxton B. F., Ruengskulrach P., Fuller J., Rosalion A., Reid C. M. et al. The right internal thoracic artery graft – benefits of grafting the left coronary system and native vessels with a high-grade stenosis // The European Journal of Cardio-Thoracic Surgery. 2000;18:255–61.

10. Carpentier A., Guermonprez J. L., Deloche A. et al. The aorta-tocoronary radial artery bypass graft: a technique avoiding pathological changes in grafts // Ann Thorac Surg. 1973;16:111–121.

11. National guidelines for the diagnosis and treatment of lower limb artery diseases 2019. URL: http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (accessed: 17.02.2021). (In Russ.).

12. News ACTS 2022. URL: https://www.tctmd.com/news/adjunctive-radialartery-grafts-no-better-svgs-multivessel-cabg (accessed: 15.03.23).

13. Acar C., Jebara V.A., Portoghese M. et al. Revival of radial artery for coronary artery bypass grafting // Ann Thorac Surg. 1992;54:652–660.

14. Mikhailov K. M., Kuznetsov D. V., Nefedova I. F., Nikolaeva E. N., Gevorgyan A. A. et al. Morphological and histological changes in the human radial artery in multifocal atherosclerosis // Grekov’s Bulletin of Surgery. 2021;180(5):1219. Doi: 10.24884/0042-4625-2021-180-5-12-19. (In Russ.).

15. Mikhaylov K. M., Kuznetsov D. V., Khokhlunov S. M., Novokshenov V. V., Kryukov A. V., Nikolaeva E. N. Period of save use of radial artery in coronary artery bypass surgery after previous catheterization // Cardiology and Cardiovascular Surgery. 2021;14(2):145–148. Doi: 10.17116/kardio202114021145. (In Russ.).

16. Harutyunyan V. B. Radial artery as an alternative conduit in the surgical treatment of IHD // Bulletin of the A. N. Bakulev RAMS. 2009;4:3:76–80. (In Russ.).

17. Vardikov D. F., Yakovleva E. K. Diagnostic capabilities of multispiral computed tomography coronary angiography in diseases of the coronary arteries // Bulletin of New Medical Technologies. 2014;21(4):44. Doi: 10.12737/7267. (In Russ.).

18. Wang J., Chen X. M., Wang S. H., Ye H. H., Cui H. B. et al. Diagnostic value of 320‐slice computed tomography coronary angiography to assess in-stent restenosis // Zhonghua Xin Xue Guan Bring Za Zhi. 2012; 40(6):487–491.

19. Kroft M. Metaanalysis of 40- and 64-MDCT angiography for assessing coronary artery stenosis // American Journal of Roentgenology. 2008; 191(6):1667–1675. Doi: 10.2214/AJR.07.4022.

20. Tranbaugh R. F., Dimitrova K. R., Lucido D. J., Hoffman D. M., Dincheva G. R. et al. The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery // J. Thorac. Cardiovasc. Surg. 2014;147:133– 140. Doi: 10.1016/j.jtcvs.2013.08.040.

21. Tilling L., Hunt J., Donald A., Clapp B., Chowienczyk P. Arterial injury and endothelial repair: rapid recovery of function after mechanical injury in healthy volunteers // Cardiology Research and Practice. 2014; 2014:367537. Doi: 10.1155/2014/367537.

22. Wagener J. F., Rao S. V. Radial artery occlusion after transradial approach to cardiac catheterization // Curr Atheroscler Rep. 2015;17:489. Doi: 10.1007/s11883-015-0489-6.


Supplementary files

Review

For citations:


Khokhlunov S.M., Kuznetsov D.V., Gevorgyan A.A., Mikhailov K.M., Nefedova I.F., Nikolaeva E.N., Taumova G.H., Garbuz O.V., Yokubov M.M. Functional state of coronary shunts from the radial artery in the presence of morphological changes in its wall. Grekov's Bulletin of Surgery. 2023;182(2):38-45. (In Russ.) https://doi.org/10.24884/0042-4625-2023-182-2-38-45

Views: 223


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 0042-4625 (Print)
ISSN 2686-7370 (Online)