Embracing artery-only bypasses

For over two decades, Royal Melbourne Hospital and University of Melbourne Professor Alistair Royse and his colleagues have been doing something that the vast majority of surgeons globally have been reluctant to do.

Australian researchers are using one of the two arteries in our forearms, the radial artery, which, they say, has proven more durable than using veins to bypass blocked arteries near the heart.

In around 95% of bypass operations, the practice is to use veins from the legs, in combination with one of the chest wall arteries. That is despite half of veins used in heart bypasses becoming completely blocked within 10 years of surgery, said The University of Melbourne in a statement.

Professor Royse hopes his research and the rising evidence in favour of artery-only bypasses will drive a change in global practice.

The study, published in the Journal of the American College of Cardiology (JACC), found that arms and hands can easily cope without the radial artery because the parallel “ulnar” forearm artery can cope on its own.

The follow-up study of 86 patients who had their radial arteries harvested between 12 and 22 years ago found blood flow to the arm and hand was unaffected, whether at rest and or during exercise.

“What was interesting and exciting was how the ulnar artery adapts to be able to compensate for the removal of the radial artery,” said University of Melbourne research student Megan O’Donnell, who conducted the study with Professor Royse.

Professor Royse has also published research showing that people with artery-only bypasses have better survival rates. This includes an analysis of 51,113 heart bypass patients from Australia and New Zealand that has now been published in the European Journal of Cardio-Thoracic Surgery and a separate study of 880 Royal Melbourne patients going back to 1996 published in the JACC.

Professor Royse said he is surprised the medical profession internationally is still yet to embrace artery-only bypasses. He believes this is partly due to reasonable caution about any new medical procedures, but also to a lack of experience in harvesting the radial artery.

“Change isn’t just about following the scientific evidence,” he said. “There are human factors at work that are sometimes just as important or more so. But maybe now we are approaching a seismic shift where the evidence is just so substantial that people will start changing.”

Image credit: ©SCHMaster/Dollar Photo Club

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