Previously catheterised radial arteries show lower bypass graft patency in CABG patientsShould surgeons avoid using a previously catheterized artery for heart bypass?

BACKGROUND: Transradial catheterisation is the default approach of coronary angiography, and the radial artery (RA) is a popular conduit choice for coronary artery bypass grafting (CABG). Whether a previously catheterised RA (CRA) remains an optimal bypass conduit for CABG is uncertain. This systematic review and meta-analysis sought to evaluate the previous CRA bypass graft patency. METHOD: A systematic search is conducted in MEDLINE, Embase, and Scopus for comparative studies of CRA versus non-CRA (NCRA) grafts. The primary outcome of this study was RA graft patency. Random-effects models generated pooled effect sizes with heterogeneity assessed by I; small-study effects were examined with funnel plot/Egger's test, and influence analyses were performed in the meta-analysis. RESULTS: Of the 1,661 studies screened, four observational studies of 400 patients (175 CRA and 379 NCRA grafts) were included in the analysis. Across the included studies, the mean time from catheterisation to CABG was 27.4±16.0 days; the mean follow-up imaging was conducted at 2.06±1.88 years. CRA graft patency was lower than NCRA (73.2% vs 83.9%), and the pooled odds of graft failure were higher with CRA (odds ratio 1.82; 95% confidence interval 1.26-2.61; p=0.001; I=33%). There were no significant small-study biases detected on planned assessments. CONCLUSIONS: Prior transradial catheterisation is associated with reduced patency of RA bypass grafts. Surgeons should exercise caution when selecting CRA for critical targets, and prospective controlled data are needed to define patient and procedural modifiers of risk.