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