Less experienced radial operators often shy away from the radial approach in patients who have had coronary artery bypass grafting (CABG). This is likely due to concerns about increased difficulty in performing these procedures. While it is reasonable to forgo CABG patients when first learning the radial approach, experience with engaging bypass grafts should be acquired early in the learning curve for those who wish to become fully skilled radial operators and offer the approach to all of their patients.
Observational data have suggested that transradial coronary angiography of bypass grafts can be performed with similar procedural times and success rates when compared to the femoral approach. However, a recent randomized controlled trial concluded that diagnostic coronary angiography in CABG patients is more challenging from the radial approach with higher cross-over rates, greater contrast use, longer procedural times, increased fluoroscopy times, and more catheter exchanges. It should be noted that this trial was conducted at a single center and had cardiology trainees acting as the primary operators. In addition, despite the increased challenge, patient satisfaction was higher in those receiving the radial approach compared to the femoral approach. While coronary angiography in CABG patients initially may be more challenging from the radial approach, there are certain technical aspects that will facilitate successful completion of these procedures on a routine basis.