The Effects of Different Type Vasodilator Agents on Radial Artery Blood Flow: A Placebo-Controlled Clinical Study

Ahmet Feyzi Abacilar, Ugur Cetingok, Mehmet Beşir Akpınar, Omer Faruk Dogan

Kudret International Hospital, Ankara, Turkey.
The Department of Cardiovascular Surgery, Adana Numune Education and Training Hospital, Adana, Turkey.
The Department of Cardiovascular Surgery, Izmir Sifa University, Bornova Education and Training Hospital, Izmir, Turkey.

DOI: 10.4236/wjcd.2014.46039                

Abstract

Background: The radial artery (RA) is being used as a second arterial conduit in coronary artery bypass grafting (CABG) patients. Vasospasm during the harvesting is the most common problem, yet. Our goal of this research is to evaluate the effects of different vasodilators on RA blood flow. Material and Method: In our 250 CABG patients who were included into the study, patients were divided into five groups which have the same number of the patients. Before the harvesting of the RA, Allen test and modified Allen test were performed. In group 1, sodium nitroprusside (SNP) was administered via central line. In group 2, nitrogliceryne was applied as a vasodilator agent. In group 3, diltiazem as a calcium channel blocker was used. In group 4, dobutamine was used with a dose of 3micro./kg/min. In the remaining patients, as a control group (CG), normal saline solution was used with the same protocol. RA length and radial artery flow, mean arterial blood pressure, central venous pressure, and heart rate were measured before and 10 minutes after drug administration. Results: No significant differences were found between the groups in respect to age, body surface area, cardiopulmonary bypass time, aortic cross clamp time. A multivariate general linear model was created and revealed the drug (specifically SNP and nitroglycerin) as a predictor to increase flow in the radial artery (p = 0.001 and p = 0.002), respectively. SNP has significantly decreased mean arterial pressure when we compared to nitroglycerin (p < 0.001). The blood flows of RA after dobutamine and calcium channel blocker administration has not changed significantly  (p > 0.05). Conclusions: Our study showed that SNP and nitroglycerin are very effective agents to provide the increasing of RA blood flow. However, statistical comparisons exhibited that intravenous SNP was a very effective vasodilating agent for RA than nitroglycerin.

Keywords

Radial Artery, Vasospasm, Coronary Artery Bypass Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Basket, R.J.F., Cafferty, F.H., Powell, S.J., Kinsman, R., et al. (2006) Total Arterial Revascularization Is Safe: Multicenter Ten-Year Analysis of 71,470. The Annals of Thoracic Surgery, 81, 1243-1248. http://dx.doi.org/10.1016/j.athoracsur.2005.12.005
[2]	Wendler, O., Hennen, B., Demertzis, S., et al. (2000) Complete Arterial Revascularization in Multi-Vessel Coronary Artery Disease with 2 Conduits (Skeletonized Grafts and T Grafts). Circulation, 102, III-79-III-83. http://dx.doi.org/10.1161/01.CIR.102.suppl_3.III-79
[3]	Legare, J.F., Buth, K.J., Sullivan, J.A. and Hirsch, G.M. (2004) Composite Arterial Grafts versus Conventional Grafting for Coronary Artery Bypass Grafting. The Journal of Thoracic and Cardiovascular Surgery, 127, 160-166. http://dx.doi.org/10.1016/j.jtcvs.2003.06.016
[4]	Buxton, B., Fuller, J., Gaer, J., et al. (1966) The Radial Artery as a Bypass Graft. Current Opinion in Cardiology, 11, 591-598. http://dx.doi.org/10.1097/00001573-199611000-00006
[5]	Arnaudov, D., Cohen, A.J., Zabeeda, D., et al. (1996) Effect of Systemic Vasodilators on Internal Mammary Flow during Coronary Bypass Surgery. The Annals of Thoracic Surgery, 62, 1816-1819. http://dx.doi.org/10.1016/S0003-4975(96)00741-2
[6]	Sasson, L., Cohen, A.J., Hauptman, E. and Schachner, A. (1995) Effect of Topical Vasodilators on Internal Mammary Arteries. The Annals of Thoracic Surgery, 59, 494-496. http://dx.doi.org/10.1016/0003-4975(94)00896-F
[7]	Cooper, G.J., Wilkinson, G.A.L. and Angelini, G.D. (1992) Overcoming Perioperative Spasm of the Internal Mammary Artery: Which Is the Best Vasodilator? The Journal of Thoracic and Cardiovascular Surgery, 104, 465-468.
[8]	Izzat, M.B., West, R.R., Ragoonanan, C. and Angelini, G.A. (1994) Effect of Systemic Vasodilators on Internal Mammary Artery Flow. The Journal of Thoracic and Cardiovascular Surgery, 108, 82-85.
[9]	Chardigny, C., Jebara, V.A., Acar, C., et al. (1993) Vasoreactivity of the Radial Artery, Comparison with the Internal Mammary and Gastroepiploic Arteries with Implications for Coronary Artery Surgery. Circulation, 88, 115-127.
[10]	Liu, J.J., Chen, J.R. and Buxton, B.F. (1996) Unique Response of Elderly Human Arteries to Endothelin ET Receptor Agonist and Antagonist. Clinical Science, 90, 91-96.
[11]	Van Son, J.A., Smedts, F., Vincents, J.G., et al. (1990) Comparative Anatomic Studies of Various Arterial Conduits for Myocardial Revascularization. The Journal of Thoracic and Cardiovascular Surgery, 99, 703-707.
[12]	He, G.-W. and Yang, C.-Q. (1996) Use of Verapamil and Nitroglycerin Solution in Preparation of Radial Artery for Coronary Grafting. The Annals of Thoracic Surgery, 61, 610-614. http://dx.doi.org/10.1016/0003-4975(95)00920-5
[13]	Dogan, O.F., Tatar, I., Duman, U., Yorgancioglu, C., Demircin, M., Aldur, M., Celik, H.H. and Boke, E. (2006) Comparison of the Pretreatment Effects of Mixed Vasodilators (3-D Solution) on Radial and Internal Thoracic Arteries by Using a 3-Dimensional Anaglyph Electron Microscope Technique. The Heart Surgery Forum® (HSF), 9, 643-649. http://dx.doi.org/10.1532/HSF98.2006-1006
[14]	Zabeeda, D., Medalion, B., Jackobshvilli, S., et al. (2001) Comparison of Systemic Vasodilators: Effects on Flow in Internal Mammary and Radial Arteries. The Annals of Thoracic Surgery, 71, 138-141. http://dx.doi.org/10.1016/S0003-4975(00)02227-X