Impact of Fascial Orientation of the Radial Artery Graft on Mid-Term Patency and Clinical Outcome

Background: The radial artery (RA) is widely used as a conduit in coronary artery bypass grafting. Its fascial layer provides mechanical stability but may reduce graft flexibility and promote kinking when routed over the margo acutus during right coronary artery bypass. This study investigated the impact of graft fascial orientation on RA patency and clinical outcomes. Methods: In this retrospective observational cohort study with prospective follow-up, 100 patients undergoing CABG with the RA grafted to the right coronary artery were included. Patients were assigned to a “prone” group (n = 50), with the fascial side oriented toward the sternum, or a “supine” group (n = 50), with the fascia facing the epicardium. Clinical follow-up was performed after a mean of 4.25 years. MDCT-based graft patency assessment was available in 89 patients. Results: Overall survival at follow-up was 100%, with no postoperative myocardial infarctions or reoperations. Overall RA patency was 94%, with patency rates of 91.5% in the supine group and 97.6% in the prone group (p = 0.37). Internal mammary artery and saphenous vein graft patency rates were 92.8% and 96.4%, respectively. Competitive flow showed a near-significant association with RA occlusion (p = 0.09). Conclusions: RA grafts demonstrated excellent mid-term patency. Fascial orientation of the pedicled RA graft was not significantly associated with graft patency.