Harvesting the radial artery: does it affect early postoperative hand function?

Retrospective analysis of local sensorimotor deficits after radial artery harvesting for coronary artery bypass grafting

OBJECTIVES

The radial artery (RA) has gained widespread acceptance as a conduit for coronary artery bypass. We analyze patient-based data to determine risk factors for long-term upper limb morbidities associated with RA harvest for coronary artery bypass grafting.

STUDY DESIGN/METHODS

Between April 1997 and March 2004, a total of 1030 patients underwent RA harvesting for coronary artery bypass grafting for a total of 1704 harvest sites. Patients were contacted by telephone and asked to report any ongoing severe sensory and functional motor deficits for each harvest site since surgery. Retrospective chart review was performed and preoperative risk factors were evaluated. Patient-based risk factors were evaluated for development of significant long-term local sensorimotor deficits including gender, elderly age (>70 y), diabetes, smoking, and whether the RA was harvested from the dominant hand.

RESULTS

Successful evaluation of 629 patients for a total of 1048 RA harvest sites was completed. The mean follow-up time was 48.3 mo (range, 2 to 86 mo). The mean age of the patients analyzed was 62.2 y. On statistical analysis, diabetics and elderly did not report significantly greater functional or sensory deficits than nondiabetics and nonelderly, respectively. There was a significantly higher incidence of sensory deficits in smokers compared with nonsmoker patients (4.2% versus 1.4%; P = 0.005) but no difference in their functional impairment was noted. Harvesting from the dominant hand did not influence the occurrence of sensory or motor functional deficits.

CONCLUSIONS

RA harvesting for coronary artery bypass grafting can be done with minimal serious long-term upper limb morbidity in higher risk patients. Based on our findings, harvesting of the RA from the dominant hand is not contraindicated in these patients.

Long-Term Physical Activity and Neurologic Function After Harvesting of the Radial Artery as T-Graft or Free Graft in Coronary Revascularization

BACKGROUND

Radial artery grafts in coronary revascularization are frequently used, either as a T-graft or as a free radial graft such as a saphenous venous graft. Besides the neurologic function of the hand after radial artery harvesting, which is questioned especially in the long-term perspective, no data on patients' lifestyle are available in this special cohort. Therefore we focused on both the patients' neurologic function as well as level of physical activity, along with their body mass index and smoking habits in this prospective, long-term study.

METHODS

Two hundred eleven patients (187 males; 64 +/- 8 years; mean Canadian coronary scale, 2.4 +/- 0.7; ejection fraction, 59 +/- 15%) were enrolled and scheduled for elective radial artery harvesting in an open conventional technique. Follow-up of 26 +/- 5 months (range, 13 to 37 months) was performed by a direct telephone interview with patients, which was 100% complete. The majority of radial arteries were used in the T-graft technique (73.9%), 24.2% were used as a free graft, and 1.4% as a jump graft.

RESULTS

One hundred sixty-five patients (78.2%) did not complain of any neurologic deficit at all. Numbness was distributed among the thumb (5.2%), the wrist (4.3%), and the incision site (3.3%). Hyposensitivity was predominantly at the wrist, followed by the thumb. Pain was distributed at the wrist (1.9%) and the thumb (1.5%). Aggravated sense of cold at the donor hand was evident in 11 patients (5.2%). No patient was compromised in their daily activities, such as piano playing or writing. Subjective well being improved in 147 patients (69.7%), was unchanged in 39 patients (18.5%), and was worse in 11 patients (5.3%) after radial artery harvesting. The mean Canadian coronary scale class improved significantly (1.3 +/- 0.6; p < 0.05). There were patients (44.5%) who performed no sports activity after the procedure and patients (11.8%) who performed sports every day of the week. There were patients (80.1%) who did not participate in heart sport groups, with only 27 patients (12.8%) participating in such heart sport groups once a week. One hundred seventy-one patients (81.0%) attended a cardiac rehabilitation program after the procedure. Body mass index did not change at all. There were patients (29%) who stopped smoking as of the procedure, whereas 10% of patients were active smokers 25 months after the procedure.

CONCLUSIONS

Radial artery harvesting is associated with a minor number of neurologic complications such as numbness and hyposensitivity after a conventional pedicled harvesting technique without any compromise on patients' daily activities. Further emphasis has to be taken in the promotion of lifestyle changes after coronary revascularization. About half of the patients did not perform any regular physical activity 2 years after surgery; mean body mass index did not change; and nearly 10% continued to smoke.

Palmar Microcirculation After Harvesting of the Radial Artery in Coronary Revascularization

PURPOSE

To evaluate real-time parameters of palmar microcirculation before and after harvesting of the radial artery in coronary revascularization using a laser Doppler flowmetry and remission spectroscopy system (O2C).

DESCRIPTION

Fifteen patients (11 males, 54 +/- 4 years, mean New York Heart Association [NYHA] class of 2.3 +/- 0.3) were prospectively scheduled with control measurements of the fingertips of D1, D3, and D5 at base line, after suprasystolic, and after selective radial or ulnar compression for tissue oxygen saturation (SO2), postcapillary venous recombinant hemoglobin (rHb) concentration, superficial (2 mm) blood flow, and deep (8 mm) blood flow.

EVALUATION

Preoperatively during suprasystolic compression SO2 decreased significantly for the fingertips of D1, D3, and D5 by -58%, -74%, and -63%, respectively (p < 0.05). Radial compression reduced SO2 for all fingertips (-12%, -14%, and -16%), as did ulnar compression (-24%, -18%, and -10%). rHb did not change significantly for either compression type. Superficial and deep blood flow decreased significantly after suprasystolic and only slightly after radial and ulnar compression at either side. No side differences were noted. After radial artery harvesting, microcirculatory parameters did not change considerably versus preoperatively.

CONCLUSIONS

Radial artery harvesting does not remarkably change microcirculatory parameters of the hand. The O2C system is a safe and quantitative method to assess both preoperatively and postoperatively the palmar microcirculation and therefore adds further functional clinical information.

Use of “Bonnet” Bypass with Radial Artery Interposition Graft in a Patient with Recurrent Cranial Base Carcinoma: Technical Report of Two Cases and Review of the Literature

OBJECTIVE AND IMPORTANCE:

Two patients with recurrent cranial base carcinomas involving the carotid artery received a “bonnet” bypass using the contralateral superficial temporal artery as the donor vessel because the ipsilateral common and external carotid arteries were unavailable. The radial artery was used as the graft.

CLINICAL PRESENTATION:

A 58-year-old man with ear pain and an enlarging mass involving the left cranial base and neck had undergone a right partial glossectomy and modified neck dissection followed by radiotherapy for squamous cell carcinoma. Recurrent carcinoma extensively involved the left internal carotid artery. A 46-year-old man with jaw pain and hoarseness had undergone multiple resections and radiation therapy for medullary thyroid carcinoma. Magnetic resonance imaging showed recurrent tumor on the right.

INTERVENTION:

Both patients underwent a pterional craniotomy. The supraclinoid internal carotid artery was exposed. The radial artery was harvested. The contralateral superficial temporal artery was dissected at its bifurcation into the frontal and parietal branches. The radial artery graft was anastomosed to the superficial temporal artery and a recipient ipsilateral branch of the middle cerebral artery. The internal carotid artery was clip-ligated. After surgery, both patients remained neurologically stable. Angiography confirmed that the bypasses were patent and that the middle cerebral artery territory filled. The patients’ carcinomas were resected aggressively.

CONCLUSION:

When aggressive resection of cranial base tumors is needed and the ipsilateral carotid artery is unavailable as a donor vessel, a “bonnet” bypass with carotid artery sacrifice may be performed. Compared with vein grafts, microsurgical anastomosis is easier and the patency rate is higher with a radial artery graft.