title: Long-term impact of radial artery harvest on forearm function and symptoms: a comparison with leg vein.
abstract: OBJECTIVE
  The radial artery (RA) has gained popularity as a conduit for coronary artery bypass surgery despite a paucity of patient-centered analysis of long-term quality of life after its removal. We sought to characterize forearm function and symptoms after RA harvest and compare these with those associated with saphenous vein (SV) removal.
  
  
  METHODS
  A total of 408 patients from an RA trial completed a questionnaire up to 14 years after primary coronary artery bypass surgery. The survey included 7 statements concerning hand and forearm symptoms or limitations in daily life and 4 questions on concerns associated with arm or leg scars. A total of 230 patients had received an RA graft (RA group). Responses were graded in order of severity from 0 to 7, with greater than 3 (mild concern) being regarded as a significant symptom. Mean response to each question and total scores were compared with the non-RA harvest group. Comparisons were also made with responses to the same questionnaire completed preoperatively and 3 months postoperatively. In patients who had both RA and SV removal, we compared the impact of a forearm scar on quality of life with that of a leg scar.
  
  
  RESULTS
  The mean duration of follow-up was 9.3 years (range, 4-14 years), and the response rate was 83%. In the RA group, 92% to 99% reported no significant symptoms, with the most frequent concerns relating to pain and numbness (8% each), but this was not significantly higher than in those who had not had an RA harvested. In the RA group, the mean scores for scar appearance and discomfort were 0.95 and 0.93, respectively (where 1 = no concern), suggesting satisfactory cosmesis and no impact on function. Symptom severity was significantly worse in 6 of 7 questions when compared with preoperative responses and in 4 of 7 items compared with 3-month follow-up, indicating a general deterioration in function over long-term follow-up. In those who had both the RA and SV harvested, patients reported more scar discomfort associated with SV harvest at 3 months (1.69 vs 1.34, P < .001) and in the present questionnaire (1.21 vs 0.97, P = .002). Concerns with scar appearance were no different between the arm and leg.
  
  
  CONCLUSIONS
  RA harvesting is associated with high patient satisfaction and less scar discomfort than SV removal. Overall, functionality declines with time, and a small proportion of patients seem to experience forearm pain and numbness. However, this is not different than in those without artery removal and may therefore be unrelated to the effects of surgery.
authors.affiliation: The University of Melbourne, Melbourne Medical School, Melbourne, Victoria, Australia. yingyan.zhu@gmail.com
authors.forename: Ying Yan
authors.initials: YY
authors.lastname: Zhu
authors.forename: Philip A R
authors.initials: PA
authors.lastname: Hayward
authors.forename: Ignatius E
authors.initials: IE
authors.lastname: Hadinata
authors.forename: George
authors.initials: G
authors.lastname: Matalanis
authors.forename: Brian F
authors.initials: BF
authors.lastname: Buxton
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Stewart
authors.forename: David L
authors.initials: DL
authors.lastname: Hare
mesh_terms: D000203:Activities of Daily Living; D002921:Cicatrix / Q000209:etiology; D001026:Coronary Artery Bypass; D005260:Female; D005542:Forearm / Q000098:blood supply* / Q000294:innervation; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply* / Q000294:innervation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011788:Quality of Life; D017534:Radial Artery / Q000637:transplantation*; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D011795:Surveys and Questionnaires; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome