Commentary: Radial artery tips from Melbourne: We stand on the shoulder of giants

Abstract

While we owe the reintroduction of the radial artery (RA) in coronary artery bypass surgery to Acar and colleagues, most of the data on its patency and outcomes come from Australia, and in particular fromMelbourne, where Buxton, Tatoulis, and Hare have been leading the field for almost 3 decades. In this issue of the Journal, Tatoulis, a recognized expert in the field of multiple arterial grafting (MAG), presents a pragmatic approach to harvesting and preservation of the RA. Due to its demonstrated superior patency rate, the RA is now used with increased frequency in international coronary practices. The recently published long-term results of the Radial Artery Patency and Clinical Outcomes (RAPCO) trial showed a significantly greater 10-year patency rate of the RA when compared with the free right internal thoracic artery and the saphenous vein. As such, the RA now seems to be the logical second choice following the gold standard left internal thoracic artery for coronary artery bypass grafting. Our group has learned much from Tatoulis and others out of Royal Melbourne Hospital, and this expert review is no exception. We use similar screening and preservation techniques as well as operative strategies. As is highlighted, it is our routine practice to use a combination of the modified Allen test with either duplex ultrasonography or index finger plethysmography to evaluate the RA for harvesting. While the time cut-off for the modified Allen