title: Persistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: a neglected side effect of coronary artery bypass grafting procedures.
abstract: OBJECTIVE
  The use of radial artery conduits in coronary artery bypass grafting (CABG) surgery is associated with improved long-term patency and patient survival rates as compared with saphenous vein conduits. Despite increasing popularity, relative incidence of local harvest-site complications and subjective perception of adverse long-term sequelae remain poorly described.
  
  
  METHODS
  To allow for direct comparison, we investigated a consecutive series of patients in whom both the radial artery and the saphenous vein had been harvested for isolated CABG during a 36-month period. Patients were identified from a prospective database that collects baseline clinical information. The patients' own perceptions were assessed by a standardized direct telephone survey regarding any persistent functional impairment from their arm and leg operation sites.
  
  
  RESULTS
  Out of 1756 CABG patients during the study period, 168 (10%) were eligible (78% men, median age: 60.1 ± 9.6 years, range: 29.6-82.4 years). Of these, 123 (73%) could be contacted and interviewed at a median follow-up time of 2.5 ± 0.9 years. Surgical wound complications at harvest sites (arms and legs) had occurred in 3% and 12%, respectively, and persistent symptoms (arms and legs) were self-reported as follows: chronic pain (5% and 8%), numbness (32% and 34%) and paresthesia/dysesthesia (14% and 7%). Overall, 39% of the patients reported persistent discomfort at the arm and 39% at the leg. Both sites were simultaneously affected in 21% (P = n.s., paired testing). Logistic regression modeling showed that patients with adverse long-term sequelae were younger (P < 0.005), had a higher body mass index (P < 0.05) and a lower EuroSCORE (P < 0.001) at the time of operation (EuroSCORE, European System for Cardiac Operative Risk Evaluation). Perioperative wound complications, however, did not predict persistence of symptoms.
  
  
  CONCLUSIONS
  Persistent harvest-site discomfort occurs with astonishing frequency after CABG surgery and affects arms and legs equally. Although usually considered a minor complication, long-term limitation to quality of life may be substantial, particularly in younger and relatively healthy patients. Thus, harvest-site discomfort clearly belongs to the list of possible post-CABG complications of which patients need to be aware.
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Dick
authors.forename: Ana
authors.initials: A
authors.lastname: Hristic
authors.forename: Eva
authors.initials: E
authors.lastname: Roost-Krähenbühl
authors.forename: Thierry
authors.initials: T
authors.lastname: Aymard
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: Hendrik T
authors.initials: HT
authors.lastname: Tevaearai
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000294:innervation; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology / Q000209:etiology; D007866:Leg / Q000294:innervation; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology; D010292:Paresthesia / Q000453:epidemiology / Q000209:etiology; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D017534:Radial Artery / Q000601:surgery* / Q000637:transplantation; D012501:Saphenous Vein / Q000601:surgery* / Q000637:transplantation; D012678:Sensation Disorders / Q000453:epidemiology / Q000209:etiology*; D013557:Switzerland / Q000453:epidemiology; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods