Extrafascially harvested radial artery in CABG: technique of harvest, complications, and mid-term angiographic patency.
BACKGROUND
The initial use of radial artery (RA) for myocardial revascularization was abandoned due to high incidence of early occlusion. The revival of radial artery graft use was attributable to the improved harvesting techniques as well as the introduction of antispasm prophylaxis by calcium channel blockers. Various techniques of harvesting RA have been described and extrafascial harvest is one of the techniques to minimize trauma during harvest. The immediate arm complications and mid-term angiographic patency of the radial artery grafts harvested using extrafascial no-touch technique and used as a conduit for myocardial revascularization were not documented well in the literature.


METHODS
Between January 1997 and February 2003, 385 patients were operated for coronary artery bypass grafting using radial artery graft as one of the conduits. We used extrafascial no-touch technique and a coagulation current cautery at a strength of 10 to 15 W to control the bleeding during the blunt dissection of the radial artery. The complications related to the radial artery harvest were prospectively recorded and analyzed. This conduit was used as a free graft in 272 patients, left internal mammary artery and radial artery Y graft in 61 patients, Right internal mammary artery, and radial artery composite in situ graft in 52 patients. The radial artery donor arm in these patients was evaluated for complications. Angiographic evaluation of the radial artery graft was carried out randomly in 51 patients and angiography was done after an interval of 6 to 72 months (mean 29.55 +/- 21.77 months).


RESULTS
In two patients, although the preoperative Allen test was negative, the radial artery was not harvested after completion of the dissection and was left in situ because the pulse could not be felt in the radial artery distal to the clamp after trial occlusion of the mid part of RA. The arm complications noticed were cutaneous parasthesias in 9 patients (2.33%), which subsided in 4 weeks, stitch abscess and superficial wound infection in 4 patients (1.03%), hematoma/seroma treated with drainage in outpatient department in 3 patients (0.78%), and wound infection requiring open drainage in an operating room in one patient (0.76%). Angiographically radial artery was patent in 48 of 51 patients (94.11%).


CONCLUSIONS
The extrafascial technique of radial artery harvest is safe and an easily reproducible method with minimal arm complications and good mid-term clinical and angiographic results. The mid-term angiographic patency rates of RA harvested using this technique are comparable to that of the published results of intrafascially harvested radial artery grafts and left internal mammary artery grafts.
Sajja
Lokeswara Rao
LR
Division of Cardiothoracic Surgery, Care Hospital, The Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. sajjalr@yahoo.com
Mannam
Gopichand
G
Sompalli
Sriramulu
S
D003097:Collateral Circulation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006225:Hand / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D014654:Vascular Patency