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Ann Thorac Surg 2001;72:1557-1561
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Functional status of the hand after radial artery harvesting: results in 3,977 cases

^a Escorts Heart Institute and Research Centre, New Delhi, India

Accepted for publication June 29, 2001.

* Address reprint requests to Dr Meharwal, Escorts Heart Institute and Research Centre, Okhla Rd, New Delhi 110 025, India
e-mail: meharwal{at}hotmail.com

	Abstract

Top Abstract Introduction Material and methods Results Comment References

 
Background. The radial artery is being used as a conduit of choice over saphenous vein with increasing frequency. We analyzed early and midterm results of coronary artery bypass grafting using radial artery as one of the conduits. The functional outcome of the hand after radial artery harvesting was analyzed.

Methods. The radial artery was used in 3,977 patients undergoing coronary artery bypass grafting between December 1996 and November 2000. Modified Allen’s test was performed preoperatively in the ward and pulse oxymetry was used in the operating theater to assess the collateral circulation of the hand. A total of 4,172 anastomoses were performed using a radial artery. The patients were followed up at regular intervals in the outpatient clinic or were sent questionnaires. The functional results of the hand were assessed. Follow-up angiography was performed in 104 patients at a mean of 18 months.

Results. The hospital mortality was 0.8%. Perioperative myocardial infarction occurred in 1.3% of patients. The average number of grafts was 3.12. No patient had acute ischemic injury of the hand. Follow-up was complete in 94% of patients. Late infection developed in 0.4% of patients. Numbness and paresthesias continued in 6.5% and 3% patients, respectively, after 3 months. The patency rate of the radial and left internal mammary artery was 92.3% and 96.0%, respectively, at a mean of 18 months.

Conclusions. Use of radial artery for coronary artery bypass grafting is associated with low morbidity and good functional outcome of the hand. It can be used more frequently as the conduit of choice after the internal mammary artery.

	Introduction

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The radial artery, which was introduced as a conduit in 1973 by Carpentier and associates [1] and abandoned because of disappointing results [2–4], is again being used as a conduit of choice by many surgeons because of good early and midterm results [5–9]. The short- and long-term effects of radial artery harvesting on the function of the arm and hand is an important issue. Various tests have been advocated to show the adequacy of collateral circulation of the hand, including the Allen’s test [10], modified Allen’s test [11], Doppler examination [12], pulse oxymetry, and back bleeding at the time of operation. Major hand ischemia is rare, but even minor complications and some functional impairment of the hand can be quite troublesome and cause financial loss to the patient. Various techniques have been described for safe harvesting of the radial artery [13–16]. In this study we analyzed the midterm results of coronary artery bypass grafting using the radial artery and functional outcome of the hand after radial artery harvesting.

	Material and methods

Top Abstract Introduction Material and methods Results Comment References

 
Data were collected prospectively on 3,977 patients who received a radial artery as one of the conduits for coronary revascularization between December 1996 and November 2000. During the same period, a total of 7,940 isolated coronary artery procedures were performed at our institute. Patients older than the age of 65 years and patients undergoing emergency operations were not considered as candidates for radial artery harvesting. We started using the radial artery at the end of 1996, but it became a routine conduit by the end of 1997 only.

Preoperative assessment
The modified Allen’s test was performed preoperatively in the ward. In the operating theater, pulse oxymetry was used to assess the collateral circulation of the hand. The saturation probe was applied to the index finger of the hand. The saturation of the finger and the amplitude of the curve were noted. The radial and ulnar arteries were then occluded in turn, and saturation and curve amplitude were again noted. If the amplitude of the curve was low or the saturation did not return to normal within 10 seconds of compressing the radial artery, harvesting of the radial artery was abandoned. The nondominant hand was used for harvesting the artery.

Harvesting of radial artery
The arm from which the radial artery was harvested was placed on an armboard attached to the operating table. The arm was extended to approximately 70 to 80 degrees to avoid injury to the brachial plexus. Both arm and chest were prepared and draped together.

The distal end of the radial artery was exposed first by making a small incision above the radial styloid process. The size and quality of the artery were examined, and any calcification was noted. If the artery was considered suitable for use, the incision was extended toward the elbow to approximately 1 cm medial and distal to the biceps tendon. The tissues including deep fascia were divided to the radial artery by low-voltage diathermy. Special care was taken to avoid injury to the lateral cutaneous nerve of the forearm, especially near the wrist where it crosses the radial artery from lateral to medial side.

The radial artery lies deep to the brachioradial muscles in loose areolar tissue. It was harvested along with its vein and surrounding tissue. The branches of the radial artery were clipped by hemostatic clips on two sides and divided with scissors. In 26 cases we used a harmonic scalpel to harvest the radial artery.

Preparing the radial artery for anastomosis
The artery was divided proximally and distally after anticoagulation with heparin. The proximal end was then cannulated using a small metal cannula, and the artery was flushed with blood mixed with papaverine and nitroglycerine. Any unclipped branches were clipped at this stage. The artery was kept in heparinized blood until it was used.

Closure of hand
Proper hemostasis was achieved, and the hand was closed in two layers. No drain was inserted. In some patients when bleeding looked excessive, the hand was closed after reversing the heparin, after performing distal and proximal anastomoses.

Follow-up
Patients were followed up in the ward for any local wound complications. The patients were examined in follow-up outpatient clinic at 1, 3, and 6 months, and then at 1-year intervals. Patients were examined for local wound problems and for any vascular or neurologic complications. The neurologic assessment was done by the attending doctor based on patients’ subjective symptoms and physical examination. Patients who complained of motor weakness of the hand beyond 3 months were sent to a neurologist for further neurologic examination. Patients who did not report to our follow-up clinic were contacted either by phone or were sent questionnaires. They were asked about any infection, swelling, pain, numbness, paresthesias, sensory loss, or functional impairment in the arm from which the radial artery was harvested. Three thousand one hundred two (78%) patients reported to our follow-up clinic, whereas 636 (16%) patients were contacted by telephone or by sending questionnaire. The follow-up was complete in 94% of patients.

	Results

Top Abstract Introduction Material and methods Results Comment References

 
Between December 1996 and November 2000, 3,977 patients received a radial artery for coronary artery bypass grafting. The mean age of the patients was 54 ± 8 years (range, 24 to 80 years). Two hundred fifty-eight (6.5%) patients were women and 3,719 (93.5%) were men.

Patient demographics are shown in Table 1. A significant number of patients had diabetes, and peripheral vascular disease was present in 8.9% of patients. The artery was harvested from the left forearm in 3,917 (98.5%) patients, and the right radial artery was harvested in 60 (1.5%) patients.

Cardiopulmonary bypass was used in 3,039 (76.4%) patients, and 938 (23.6%) patients were operated on without cardiopulmonary bypass, using beating heart techniques. The average number of grafts was 3.12.

Postoperative results
The overall hospital mortality was 0.8% (32 patients). Postoperative complications are shown in Table 3. The mean intensive care unit stay was 22 ± 9 hours, and the mean hospital stay was 6 ± 2 days.

Follow-up
We conducted follow-up on 3,738 patients from 3 months to 4 years (mean follow-up, 22 months). The results of follow-up for late complications and functional status of the hand are shown in Table 4. There were 15 (0.6%) late infections, all of which responded to antibiotics and local dressing of the wound. Six patients (0.16%) had wound dehiscence and required resuturing. The numbness and paresthesia continued beyond 3 months in 242 (6.5%) and 112 (3%) patients, respectively (Table 4). Only 46 (1.22%) patients complained of these symptoms beyond 6 months. None of the patients had any major vascular or neurologic complications. All but 9 patients were using the hand normally within 3 months. Nine patients who said they had limitation in normal activity were sent for neurologic consultation and were found to have normal motor neurologic examination. Sixty (1.6%) patients were found to have objective evidence of sensory loss in the area of the lateral cutaneous nerve of the forearm. No patient lost hand function or tissue during follow-up.

On clinical evaluation 3,327 (89%) patients were in New York Heart Association functional class I or II, and 336 (9%) patients were in class III.

	Comment

Top Abstract Introduction Material and methods Results Comment References

 
The radial artery is a surgeon-friendly conduit and technically easier to use than other arterial conduits. With more evidence coming in favor of good midterm patency rates of the radial artery [5, 17], the use of this vessel as one of the conduits for coronary artery bypass grafting has increased. We started using the radial artery in 1996, and our use of this conduit is increasing with each year. We use the radial artery as the second conduit of choice in patients who are younger than 65 years of age, except when we can use the right internal mammary artery as a pedicled graft for the right coronary artery, in which case it becomes our third conduit of choice.

We performed the modified Allen’s test and digital pulse oxymetry before harvesting the radial artery. We did not notice any acute ischemic complications of the hand in our patients. Fox and colleagues [18] reported a case of acute upper limb ischemia after radial artery harvesting. The complication occurred after 2 days; subclavian angiogram demonstrated congenital absence of the ulnar artery, and the patient was managed by brachioradial bypass using a cephalic vein. We have found pulse oxymetry to be a reliable method for assessing palmar collateral circulation.

Routine use of the radial artery has been shown not to increase the complexity or morbidity of coronary artery bypass grafting [19]. If total arterial revascularization can be performed, it avoids the morbidity of a leg incision and can promote early postoperative mobilization [20].

The incidence of minor hand complications in our study, both in hospital and during follow-up, was quite acceptable. Numbness and paresthesias were the most common complaints, which disappeared between 3 and 6 months in 98.8% of patients. None of the patients had motor deficit on follow-up. One of the limitations of these neurologic findings is that the assessment was based on patients’ symptoms and examination by a nonneurologist. Only a small number of patients who complained of motor weakness beyond 3 months were sent for formal neurologic examination by a neurologist. Royse and coworkers [16] tested hand strength in 328 nonselected patients and found that it was not reduced by radial artery harvest when hand dominance was taken into account. They observed objective sensory loss in 0.3% of patients for superficial radial nerve and 2.1% for lateral cutaneous nerve of the forearm. We observed this complication in 1.6% of our patients. We believe that meticulous dissection and minimal use of diathermy is crucial in avoiding neurologic sequelae of radial artery harvesting.

A significant number of our patients had diabetes, but healing has not been a problem even in this group of patients.

Various techniques of radial artery harvesting have been described, including ultrasonically activated scalpel [15] and endoscopic harvesting. We harvest the radial artery using low-voltage diathermy and applying clips on both sides of the branches. Ronan and colleagues [21] found that ultrasonic dissection of the radial artery was associated with decreased radial artery spasm and good hemostasis without adding to the harvest time.

We have been harvesting the radial artery from the nondominant hand, although some surgeons have been using bilateral radial arteries to extend the scope of arterial myocardial revascularization [22]. Most of our patients did not agree to have bilateral radial artery harvesting.

We prefer to use the radial artery for the left coronary artery system, but if the right coronary artery system has large areas of myocardial supply, we also use it for the right coronary artery or posterior descending artery. We normally get enough length of the radial artery to reach any coronary vessel except in small-stature women, for whom length sometimes is a limiting factor. The diameter of the lumen of the radial artery corresponds well to most recipient coronary vessels [23], and the thick muscular wall is appropriate for both aortic and coronary anastomoses [23, 24].

The midterm patency rate (92.5%) of the radial artery in our study was comparable to that of other studies [5, 17, 25]. The patency rate was better than for veins, as has been demonstrated by many other studies [6, 26]. However, inasmuch as the angiography was performed in a very small number of patients (2.6%), it is not possible to make any conclusion about the patency rate of the conduits in the whole population in the study.

We believe that by paying attention to harvesting technique, good functional results can be achieved with the radial artery. With encouraging midterm results and no major morbidity attached to radial artery harvesting, its use should be increased in myocardial revascularization.

	References

Top Abstract Introduction Material and methods Results Comment References

 

1. Carpentier A., Guermonprez J., Deloche A., Frechette C., DuBost C. The aorta-to-coronary radial artery bypass graft: a technique avoiding pathological changes in grafts. Ann Thorac Surg 1973;16:111-121.[Medline]
2. Curtis J.J., Stoney W.S., Alford W.C., Jr, Burrus G.R., Thomas C.S., Jr Intimal hyperplasia: a cause of radial artery aortocoronary bypass graft failure. Ann Thorac Surg 1975;20:628-635.[Abstract]
3. Chiu C.J. Why do radial artery grafts for aortocoronary bypass fail? A reappraisal. Ann Thorac Surg 1976;22:520-523.[Abstract]
4. Fisk R.L., Brooks C.H., Callaghan J.C., Dvorkin J. Experience with the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1976;21:513-518.[Abstract]
5. Possati G., Gaudino M., Alessandrini F., et al. Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. J Thorac Cardiovasc Surg 1998;116:1015-1021.[Abstract/Free Full Text]
6. Da Costa F., da Costa I., Poffo R., et al. Myocardial revascularization with the radial artery: a clinical and angiographic study. Ann Thorac Surg 1996;62:475-480.[Abstract/Free Full Text]
7. Acar C., Jerbara V.A., Portoghese M., et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992;52:652-660.
8. Fremes S., Christakis G.T., Del Rizzo D.F., Musiani A., Mallidi H., Goldman B.S. The technique of radial artery bypass grafting and early clinical results. J Card Surg 1995;10:537-544.[Medline]
9. Reyes A.T., Frame R., Brodman R.F. Technique for harvesting the radial artery as a coronary artery bypass graft. Ann Thorac Surg 1995;59:118-126.[Abstract/Free Full Text]
10. Dietl C.A., Benoit C.H. Radial artery graft for coronary revascularization. Ann Thorac Surg 1995;60:102-110.[Abstract/Free Full Text]
11. Ejrup B., Fischer B., Wright I.S. Clinical evaluation of blood flow to the hand. Circulation 1966;33:778-780.[Abstract/Free Full Text]
12. Jarvis M.A., Jarvis C.L., Jones P.R.M., Sypt J.T. Reliability of Allen’s test in selection of patients for radial artery harvest. Ann Thorac Surg 2000;70:1362-1365.[Abstract/Free Full Text]
13. Reyes A.T., Frame R., Brodman R. Technique for harvesting the radial artery as a coronary artery bypass graft. Ann Thorac Surg 1995;59:118-126.
14. Kulshrestha P., Rao L., Garb J.L., Rousou J.A., Engelman R.M., Wait R.B. Use of extrafascially harvested radial artery for coronary artery revascularization: technical considerations. J Card Surg 1999;14:26-31.[Medline]
15. Psacioglu H., Atay Y., Cetindag B., Saribulbul O., Buket S., Hamulu A. Easy harvesting of radial artery with ultrasonically activated scalpel. Ann Thorac Surg 1998;65:984-985.[Abstract/Free Full Text]
16. Royse G.A., Royse C.F., Shah P., Williams A., Kaushik S., Tatoulis J. Radial artery harvest technique, use and functional outcome. Eur J Cardiothorac Surg 1999;15:186-193.[Abstract/Free Full Text]
17. Acar C., Ramsheyi A., Pagny J.Y., et al. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 1998;116:981-989.[Abstract/Free Full Text]
18. Fox A.D., Whiteley M.S., Hughes P.J., Roake J. Acute upper limb ischemia: a complication of coronary artery bypass grafting. Ann Thorac Surg 1999;67:535-536.[Abstract/Free Full Text]
19. Anyawu A.C., Saeed I., Bustami M., Ilsey C., Yacoub M.H., Amrani M. Does routine use of the radial artery increase complexity or morbidity of coronary bypass surgery?. Ann Thorac Surg 2000;71:555-559.[Abstract/Free Full Text]
20. Buxton B., Fuller J., Gaer J., et al. The radial artery as a bypass graft. Current Opin Cardiol 1996;11:591-598.[Medline]
21. Ronan J.W., Perry L.A., Barner H.B., Sundt T.M. Radial artery harvest: comparison of ultrasonic dissection with standard technique. Ann Thorac Surg 2000;69:113-114.[Abstract/Free Full Text]
22. Tatoulis J., Buxton B.F., Fuller J.A. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg 1998;66:714-719.[Abstract/Free Full Text]
23. Grooters R.K., Nishida H. The radial artery. In: Grooters R.K., Nishida H., eds. Alternative bypass conduits and methods for surgical coronary revascularization. Mt. Kisco, NY: Futura, 1994:83-88.
24. Van Son J.A.M., Smedts F., Vincent J.G., van Lier H.J.J., Kubat K. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 1990;99:703-707.[Abstract]
25. Calariore A.M., Di Giammarco G., Teodori G., et al. Radial artery and inferior epigastric artery in composite grafts: improved midterm angiographic results. Ann Thorac Surg 1995;60:517-524.[Abstract/Free Full Text]
26. Chen A.H., Tatsuya N., Brodman R.F., et al. Early postoperative angiographic assessment of radial artery grafts used for coronary artery bypass grafting. J Thorac Cardiovasc Surg 1996;111:1208-1212.[Abstract/Free Full Text]

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Zile Singh Meharwal Naresh Trehan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Meharwal, Z. S. Articles by Trehan, N. Search for Related Content PubMed PubMed Citation Articles by Meharwal, Z. S. Articles by Trehan, N. Related Collections Coronary disease