Endoscopic Radial Artery Harvesting Reduces Postoperative Pain and Neurologic Complications

Authors

  • Igor Rudez
  • Daniel Unic
  • Zeljko Sutlic
  • Bojan Biocina
  • Davor Baric
  • Mira Ivkovic
  • Mirjana Pavlovic

DOI:

https://doi.org/10.1532/HSF98.20071105

Abstract

Background. Endoscopic radial artery harvest provides better cosmetic result without compromising the quality of the graft. We sought to compare postoperative harvesting site neurologic and vascular outcome.

Methods. From 10/2002 until 10/2004, 50 patients were randomized to have their radial artery harvested for coronary bypass either endoscopically (group A, n = 25) or conventionally (group B, n = 25). Radial arteries were preoperatively evaluated by Doppler echocardiography. Neurologic and functional status was assessed by a self reporting questionnaire with a semiquantitative (1-5) scale. Vascular status of the forearm was assessed by control echocardiography.

Results. At an average follow-up of 37 ± 7 months, patients undergoing endoscopic radial artery harvesting had less overall neurologic complications (11 versus 17 patients, P = .023) and they were less severe (0.8 ± 1.1 versus 2.2 ± 1.2; P < .001). Ulnar flow increase was similar among the groups: 13.1 ± 5.43 cm/s in group A versus 15.9 ± 4.9 cm/s in group B (P = .147) as well as ulnar artery diameter increase 0.29 ± 0.16 mm in group A versus 0.29 ± 0.26 cm in group B (P = .914)

Conclusion. Endoscopic radial artery is safe and does not compromise graft quality or forearm and hand circulation postoperatively. Along with providing a better cosmetic result, endoscopic artery harvesting reduces postoperative harvesting site pain and neurologic complications.

References

Acar C, Farge A, Chardigny C, et al. 1993. Use of the radial artery for coronary artery bypass. A new experience after 20 years. Arch Mal Coeur Vaiss 86:1683-9.nAziz O, Athanasiou T, Darzi A. 2006. Minimally invasive conduit harvesting: a systematic review. Eur J Cardiothorac Surg 29:324-33.nDenton TA, Trento L, Cohen M, et al. 2001. Radial artery harvesting for coronary bypass operations: neurologic complications and their potential mechanisms. J Thorac Cardiovasc Surg 121:951-6.nHata M, Raman J, Matalanis G, et al. 2002. Post harvest wound infection and patient's perception: comparative study between radial artery and saphenous vein harvest sites. Ann Thorac Cardiovasc Surg 8:97-101.nHe G-W, Yang C-Q. 1996. Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting. Ann Thorac Surg 61:610-4.nGaudino M, Serricchio M, Tondi P, et al. 2005. Chronic compensatory increase in ulnar flow and accelerated atherosclerosis after radial artery removal for coronary artery bypass. J Thorac Cardiovasc Surg 130:9-12.nIkizler M, Ozkan S, Dernek S, et al. 2005. Does radial artery harvesting for coronary revascularization cause neurological injury in the forearm and hand? Eur J Cardiothorac Surg 28:420-4.nMeharwal ZS, Trehan N. 2001. Functional status of the hand after radial artery harvesting: results in 3,977 cases. Ann Thorac Surg 72:1557-61.nPatel AN, Henry AC, Hunnicutt C, et al. 2004. Endoscopic radial artery harvesting is better than the open technique. Ann Thorac Surg 78:149-53.nPola P, Serricchio M, Flore R, et al. 1996. Safe removal of the radial artery for myocardial revascularization: a Doppler study to prevent ischemic complications to the hand. J Thorac Cardiovasc Surg 112:737-44.nRoyse AG, Royse CF, Shah P, et al. 1999. Radial artery harvest technique, use and functional outcome. Eur J Cardiothorac Surg 15:186-93.nRuengsakulrach P, Brooks M, Hare DL, et al. 2001. Preoperative assessment of hand circulation by means of Doppler ultrasonography and the modified Allen test. J Thorac Cardiovasc Surg 121:526-31.nSaeed I, Anyanwu AC, Yacoub MH, Amrani M. 2001. Subjective patient outcomes 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.nShapira OM, Eskenazi BR, Hunter CT, et al. 2006. Endoscopic versus conventional radial artery harvest—is smaller better? J Card Surg 21:329-35.nTerada Y, Uchida A, Fukuda I, et al. 1998. Endoscopic harvesting of the radial artery as a coronary artery bypass graft. Ann Thorac Surg 66:2123-4.n

Published

2007-09-13

How to Cite

Rudez, I., Unic, D., Sutlic, Z., Biocina, B., Baric, D., Ivkovic, M., & Pavlovic, M. (2007). Endoscopic Radial Artery Harvesting Reduces Postoperative Pain and Neurologic Complications. The Heart Surgery Forum, 10(5), E363-E365. https://doi.org/10.1532/HSF98.20071105

Issue

Section

Article