C. Radial Artery
The radial artery is readily accessible in the forearm, and it is used frequently by some surgeons. Spasm and throm¬bosis of the artery have been minimized by careful manipulation of the vessel and the use of long-term calcium antagonists. The patency rate for radial grafts at 5 years is approximately 80% versus 90% for internal mammary artery graft. Khot et al. have recently shown that radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts.
When coronary artery bypass surgery is selected, patients who can receive an internal mammary artery graft are most fortunate. The arterial graft has a prolonged patency of 15–20 years versus approximately 10–12 years for saphe-nous vein grafts.
D. Robotic Bypass Surgery
Robotic coronary bypass surgery using a left internal mammary artery graft to the LAD along with balloon angioplasty and stenting to non-LAD vessels that require treatment has proven successful in a small a study of 150 patients. Follow up after three years shows 100% of the mammary grafts to be patent; 3.8% of the PCI vessels were occluded, and 15% were narrowed; 10 patients had repeat PCI, and none had repeat surgery. Importantly, 96% of the patients treated with this hybrid procedure were free of symptoms at three years. Because the gold standard treatment for obstructive coronary artery disease remains a left internal mammary artery graft, there is hope that this hybrid procedure using robotic bypass surgery to the LAD and angioplasty with stent for other vessels could prove a major management strategy for the relief of symptomatic, obstructive coronary artery disease.

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