Long-term Arm Morbidity after Radial Artery Harvesting for Coronary Bypass Operation
Background: The use of the radial artery (RA) in coronary bypass operations has become increasingly popular in recent years, but there is almost no documentation regarding the midterm and long-term arm complications.
Methods: Between January 1 and December 31, 1998, 109 patients underwent operations for myocardial revascularization employing a pedicled RA as 1 of the coronary grafts. The patients were surveyed for subjective arm morbidities at 2 times during their follow-up: short term (mean, 7 months postoperatively; range, 0.3-14 months) and long term (mean, 49 months postoperatively; range, 46-57 months).
Results: At the short-term follow-up, 33 (33.3%) of the patients had some complaints regarding the arm that was operated on, with 4 (4%) of the patients reporting arm disability with complaints that focused on pain (11, 11%), numbness (15, 15%), and parasthesias (12, 12%). At the long-term follow-up, only 9 patients (10.5%) still experienced some sort of inconvenience with the arm that was operated on, with 1 case of functional disability, 4 complaints (4.6%) of residual parasthesias, and 1 report (2.3%) each of pain or numbness. All but 2 of the patients with complaints at the short-term follow-up reported amelioration of symptoms at the long-term follow-up.
Conclusion: It appears that severe arm disability early after RA harvesting is likely to dissolve with time. Our favorable late follow-up results support the continuation of the employment of the RA as a conduit for coronary artery bypass grafting operations.
Acar C, Ramsheyi A, Pagny JY, et al. 1998. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 116:981-9.nArons JA, Collins N, Arons MS. 1999. Permanent nerve injury in the forearm following radial artery harvesting: a report of two cases. Ann Plast Surg 43:299-301.nBuxton B, Fuller J, Gaer J, et al. 1996. The radial artery as a bypass graft. Curr Opin Cardiol 11:591-8.nDumanian GA, Segalman K, Mispireta LA, Walsh JA, Hendrickson MF, Wilgis EF. 1998. Radial artery use in bypass grafting does not change digital blood flow or hand function. Ann Thorac Surg 65:1284-7.nGrossebner M, Arifi A, Bourov G, Taylor G, Gray S, Ritchie A. 1999. No change in O saturation but measurable difference in thenar flexor power after radial artery harvest. Eur J Cardiothorac Surg 16:160-2.nManasse E, Sperti G, Suma H, et al. 1996. Use of the radial artery formyocardial revascularization. Ann Thorac Surg 62:1076-83.nPola P, Serricchio M, Flore R, Manasse E, Favuzzi A, Possati GF. 1996. Safe removal of the radial artery for myocardial revascularization: a Doppler study to prevent ischemic complications of the hand. J Thorac Cardiovasc Surg 112:737-44.nPossati G, Gaudino M, Alessandrini F, et al. 1998. Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. J Thorac Cardiovasc Surg 116:1015-21.nReddy S, Parikh SM, Drinkwater DC Jr, et al. 2002. Morbidity after procurement of radial arteries in diabetic patients and the elderly undergoing coronary revascularization. Ann Thorac Surg 73:803-8.nSaeed I, Anyanwu AC, Yacoub MH, Amrani M. 2001. Subjective patientoutcomes following coronary artery bypass using the radial artery: results of a cross-sectional survey of harvest site complications and quality of life. Eur J Cardiothorac Surg 20:1142-6.nSerricchio M, Gaudino M, Tondi P, et al. 1999. Hemodynamic and functional consequences of radial artery removal for coronary artery bypass grafting. Am J Cardiol 84:1353-6.nTatoulis J, Buxton BF, Fuller JA. 1998. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg 66:714-9.nTimmons MJ, Missotten FEM, Poole MD, Davies DM. 1986. Complications of radial forearm flap donor sites. Br J Plast Surg 39:176-8.n