Does radial artery harvesting for coronary revascularization cause neurological injury in the forearm and hand?
OBJECTIVE
Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits.


METHODS
A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre- and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test.


RESULTS
The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre- and postoperative radial nerve motor and sensory conduction records were statistically similar (P>0.05).


CONCLUSIONS
We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.
Ikizler
Murat
M
Department of Cardiovascular Surgery, Osmangazi University, Medicine Faculty, Visnelik Mh. Karatay Sk., No: 3/31 B-Blok, 26020 Eskisehir, Turkey. mikizler@ogu.edu.tr
Ozkan
Serhat
S
Dernek
Sadettin
S
Ozdemir
Coskun
C
Erdinc
Oguz O
OO
Sevin
Behcet
B
Ozdemir
Gazi
G
Kural
Tugrul
T
D000200:Action Potentials; D000368:Aged; D000704:Analysis of Variance; D003097:Collateral Circulation; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply / Q000294:innervation; D006225:Hand / Q000098:blood supply / Q000294:innervation; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries*; D008875:Middle Aged; D009048:Motor Skills; D009431:Neural Conduction; D010292:Paresthesia / Q000209:etiology / Q000503:physiopathology; D011184:Postoperative Period; D017534:Radial Artery / Q000637:transplantation*; D011826:Radial Nerve / Q000293:injuries; D012684:Sensory Thresholds; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods; D014459:Ulnar Nerve / Q000293:injuries