Radial artery harvesting for coronary bypass operations: neurologic complications and their potential mechanisms.
OBJECTIVE
We sought to determine the incidence of self-reported neurologic hand complications after radial artery harvest for coronary artery bypass grafting.


METHODS
Between February 20, 1996, and December 31, 1999, 615 patients underwent coronary bypass operations with radial arteries. A scripted telephone interview was performed, collecting data on perceived thumb weakness and sensation abnormalities in the distribution of the radial nerve in 560 patients. The average time to follow-up interview was 14.5 +/- 9 months.


RESULTS
Neurologic complications were reported in 30.1%, decreased thumb strength in 5.5%, and any sensation abnormality in 18.1% of patients. There was a high rate of symptom improvement over an average of 8.7 +/- 7.5 months, such that only 12.1% of patients reported symptoms without any improvement. Associations between thumb weakness and sensory abnormalities imply median nerve damage in some patients. There were statistically significant associations between neurologic complications and diabetes, peripheral vascular disease, elevated creatinine levels, smoking, and number and site of radial artery harvest.


CONCLUSIONS
The overall rate of self-reported neurologic complications after radial artery harvest was higher than previously reported. These symptoms may be attributable to radial and median nerve injury caused by trauma and devascularization. These data have important implications not only in attempting to improve harvesting techniques but also in guiding informed consent before coronary artery bypass grafting.
Denton
T A
TA
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. denton@cshs.org
Trento
L
L
Cohen
M
M
Kass
R M
RM
Blanche
C
C
Raissi
S
S
Cheng
W
W
Fontana
G P
GP
Trento
A
A
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology*; D017534:Radial Artery / Q000293:injuries / Q000637:transplantation*; D012307:Risk Factors; D013933:Thumb / Q000294:innervation* / Q000503:physiopathology; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*