Determining the best procedure for radial artery harvest: prospective randomized trial for early postharvest complications

Radial artery in myocardial revascularization

In the past decade, the use of the radial artery as a coronary artery bypass graft has been revitalized. However, there has been controversy regarding harvest techniques, antispasm protocols, and selection of target vessels. It is widely accepted that the patency of radial-artery grafts depends on the severity of native-vessel stenosis. Thus, radial artery grafts should be preferentially used for target vessels with high-grade (>75% stenosis) lesions. In this review article, we analyzed the current status of radial artery grafts as a coronary bypass conduit based on our personal experience and recently published literature data.

Harmonic scalpel versus electrocautery for harvest of radial artery conduits: reduced risk of spasm and intimal injury on optical coherence tomography

OBJECTIVE

Vasospasm is the primary obstacle to widespread adoption of the radial artery as a conduit in coronary artery bypass grafting. We used optical coherence tomography, a catheter-based intravascular imaging modality, to measure the degree of radial artery spasm induced by means of harvest with electrocautery or a harmonic scalpel in patients undergoing coronary artery bypass grafting.

METHODS

Radial arteries were harvested from 44 consecutive patients with a harmonic scalpel (n = 15) or electrocautery (n = 29). Vessels were imaged before harvesting and after removal from the arm, with saphenous vein tracts serving as internal controls. Optical coherence tomographic findings for the degree of harvesting-induced injury were validated against histologic measures.

RESULTS

Optical coherence tomographic measures of endovascular dimensions and injury correlated strongly with histologic findings. Mean luminal volume, a measure of vasospasm, decreased significantly less after harvesting with a harmonic scalpel (9% +/- 7%) than with electrocautery (35% +/- 6%, P = .015). Completely intact intima was present in 11 (73%) of 15 radial arteries harvested with a harmonic scalpel (73%) compared with 9 of 29 arteries harvested by means of electrocautery (31%, P = .011). Intraoperative flow measurements and patency rates at 5 days postoperatively were not significantly different among groups.

CONCLUSIONS

Optical coherence tomography provides a level of speed and accuracy for quantifying endothelial injury and vasospasm that has not been described for any other modality, suggesting potential as an intraoperative quality assurance tool. Our optical coherence tomographic findings suggest that the harmonic scalpel induces less spasm and intimal injury compared with electrocautery.

Radial Artery Harvest Using the Sharp Scissors Method for Patients with Pathological Findings on Allen's Test

PURPOSE

The pathological findings on Allen's test tend to be contraindicative for radial artery (RA) harvest. However, the employment of a meticulous harvest technique might help protect the collateral vessels from the interosseous arteries and thus help to maintain forearm circulation. We herein report successful RA harvest using the sharp scissors method in patients with pathological findings on Allen's test.

METHODS

Ten patients with pathological findings on Allen's test underwent RA harvest using only sharp scissors and metal clips. The distal end of the RA was left approximately 5 cm from the wrist. Using forearm thermography, the skin temperature of the harvest site was compared with that of the non-harvest site. All patients underwent postoperative forearm angiography one month after surgery.

RESULTS

No ischemic events in the forearm or harvest site complications were observed. Thermography showed no difference in the skin temperatures between the harvest and non-harvest sites in all patients. Moreover, forearm angiography 1 month postoperatively showed that the interosseous arteries to be well developed and connected to the distal end of the RA in all patients.

CONCLUSIONS

These results suggest that a meticulous RA harvest using sharp scissors and clips can help to protect from collateral perfusion of the interosseous arteries. Using this method, RA harvest is therefore considered to be acceptable even for patients with pathological findings on Allen's test.