DISCUSSION
Here we present two patients with more than 8 years after TR arterial
line or catheterization with chronic injury in the form of dissection
and obstruction of the lumen due to fibrosis. Current evidence supports
that TR procedures cause chronic and irreparable injury to the RA,
making them unusable as bypass conduit for CABG.
Sousa-Uva and colleagues recommend that the RA should de facto be
considered in every CABG.3 The group cites the
superior late graft patency compared with traditionally harvested
saphenous vein, as well as, stronger evidence of clinical benefit when
compared to the right internal thoracic artery.
Gaudino summarized the benefits of using the TR approach for
percutaneous procedures and the RA as a conduit for
CABG.4 The writing panel comprised of clinical
cardiologists, cardiothoracic surgeons, and interventional cardiologists
recommended reserving one RA for TR access and the other as a conduit
for CABG. They also recommended adoption of strategies to minimize RA
damage during TR access.
To date there are only two studies that specifically examine the impact
of previous TR procedures on the function of RA used as conduit in CABG.
Kamiya reported a stenosis- free patency rate of 77% in those with
prior RA catheterization versus 98% in the control group (no prior RA
catheterizations) at 30 days.5 The authors also
performed a subanalysis on the relationship between occurrence of graft
stenosis and TR catheterization, which indicated that the number of
previous TR catheterizations was the most likely factor affecting graft
patency (P=0.07). In a similar study, Ruzieh reported a 6- to 18-month
patency of 59% in the TR access group compared to 78% in the control
group (RA not used for angiography) (p=0.03).6