Consequences of Radial Artery Harvest

Holman, William L.; Davies, James E.; Lin, Julia; Wang, Yajie; Goldman, Steven; Bakaeen, Faisal G.; Kelly, Rosemary F.; Fremes, Stephen E.; Lee, Kelvin K.; Sethi, Gulshan K.

doi:10.1001/jamasurg.2013.3721

Cited by 8 publications

(6 citation statements)

References 16 publications

(15 reference statements)

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“…The incidence is up to 30%, but has settled by 12 months. 9 , 23 The cosmetic result with ERAH is better because it avoids the long incision; however, after 12 months most patients do not consider this to be a problem because the longitudinal incision heals well. 4 , 24 Infection is rare, <1%, although again slightly more common with ORAH.…”

Section: Anatomymentioning

confidence: 99%

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The radial artery: An important component of multiarterial coronary surgery and considerations for its optimal harvest

Tatoulis

2021

JTCVS Techniques

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There is mounting evidence from large observational studies and randomized trials (RCTs) that coronary artery bypass grafting using multiple arterial grafts (MAG) results in superior graft patency and better long-term clinical outcomes without compromising perioperative mortality and morbidity. [1][2][3] The radial artery (RA) has emerged as the second arterial graft of choice. It has the same patency as the right internal thoracic artery (ITA) when placed to the same vessels under the same conditions, but is much more versatile and easier to use. 4 Introduced in 1971 by Carpentier, lack of knowledge about arterial graft spasm and management of this with mechanical dilatation was problematic. Observation of excellent, patent, atheroma-free RA grafts from the original series 2 decades later has prompted its reappearance as a coronary graft. Advantages include ease of procurement, length (18-22 cm), robustness, versatility, excellent diameter appropriate to the coronaries, ease of constructing sequential anastomoses, potential for total arterial revascularization when used with the left ITA, especially as a T or Y graft, few infections and wound problems, suitable for use in patients with diabetes, and suitable for use in all ages, including the elderly, facilitating early ambulation. Proximally, its size generally allows direct anastomosis to the aorta or to an ITA. 4 Crucial to successful RA use is optimal harvesting, preparation to maximize its perioperative and long-term efficacy, and minimizing harvest-related complications or impediments. These include wounds, cosmesis, neurologic (particularly sensory) abnormalities, finger/hand ischemia, graft damage (especially intimal), and spasm. Therefore, knowledge of RA anatomy, assessment of hand circulation, its morphologic and pharmacologic characteristics, relationships to relevant nerves, harvest strategies, and a reproducible technique to avoid these potential complications is mandatory. AnatomyThe brachial artery bifurcates into the ulnar artery (UA) and RA at the elbow. The RA is usually smaller and fortuitously is not accompanied by any major nerves-unlike the UA (median nerve). The RA runs deep to the brachioradialis muscle and emerges between it and the flexor muscles approximately two-thirds of the way down the forearm, becoming superficial and easily accessible just above the wrist before its termination in the superficial and deep palmar arches (Figure 1).Proximally, the recurrent RA arises 1 cm distal to the RA origin and runs laterally and proximally. The interosseous artery originates from the deeper aspect. In its proximal two-thirds, the RA lies in loose areolar tissue with few branches. The branches become more numerous in the distal third, particularly around the wrist. Branches on the

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Section: Anatomymentioning

confidence: 99%

“…Although power and utility in the affected hand may be initially reduced, by 12 months there is no discernible difference. 19 , 23 , 24 …”

Section: Anatomymentioning

confidence: 99%

The radial artery: An important component of multiarterial coronary surgery and considerations for its optimal harvest

Tatoulis

2021

JTCVS Techniques

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“…An example of the above is the higher incidence of mediastinal infections associated with the use of both internal mammary arteries in some patients with risk factors described in the literature (diabetes mellitus, obesity, and chronic obstructive pulmonary disease), since the use of these conduits as pediculated grafts decreases sternal wall irrigation 4,6,8,12 . Another example is observed when the radial artery is used for grafts, because paresthesia may occur in the arm that the artery is obtained from in approximately one third of patients, although these symptoms are not that important since they are generally transient and self-limited when collaterality is appropriate 13 , which is why the Allen test should be done, accompanied by a second test, such as Doppler ultrasound, pulse oximetry, or digital pressure measurement with radial artery obstruction before using it as graft in a revascularization procedure 6 .…”

Section: Palabras Clave: Puentes Secuenciales Recurrencia Clínica Revascularización Coronariamentioning

confidence: 99%

Clinical recurrence in patients with sequential grafts in Coronary Artery Bypass Graft (CABG) surgery

Gomez-Sanchez¹,

Perezgrovas‐Olaria²,

García-Garnica³

et al. 2021

ACME

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Objective: The objective of this study was to compare the recurrence rates of revascularization (redo coronary artery bypass graft [CABG] or percutaneous coronary intervention [PCI]), new ischemic event, or death in patients with simple or sequential grafts in CABG surgery. Methods: The study design is an ambispective cohort of patients that underwent CABG by sequential grafting (n = 111) or simple grafting (n = 145) between January 1, 2013 and December 31, 2017. Patients had to be 18 years old at the time of surgery, undergoing their first on-pump CABG. The clinical record of every patient was carefully reviewed and patients who had incomplete follow-up in external consultation were contacted by telephone to obtain data about ischemia related reintervention (CABG or PCI), new documented ischemic event, or death caused by coronary artery disease, Kaplan-Meier estimators were calculated. Results: The proportion of recurrence depending on technique was not statistically different: sequential (6.5% [CI 95% 2.6-12.6%] versus simple 4.8% [CI 95% 2-9.7%], p = 0.60, Bayesian analysis BF 10 = 0.37; moderate evidence to no difference), each one related to new ischemic event and one death per group. There were no differences in follow-up time (sequential 59m simple 66m ). No difference was found regarding recurrence incidence rates; sequential 1.99 events × 10 3 months-patient, versus simple 1.47 (HR=1.34; p = 0.58). Pump and cross-clamping times were lower for sequential technique (41.44 min; 24.69 min respectively) versus simple technique (43 min and 26.4 min, respectively) with a p = 0.7 after adjusting to mean grafts per surgery (2.7 simple; 3.25 sequential, p < 0.001). Conclusions: Both techniques had a low incidence of clinical recurrence, without significant differences between procedures.

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“…comprehensive 100-point questionnaires and measured hand grip using a dynamometer, 23 nerve conduction studies, 24 or detailed manual examination. 25 Tamim and colleagues conclude that, in experienced hands, ERAH can be performed safely and effectively with no difference in short-term graft-related outcomes.…”

Section: Author Manuscriptmentioning

confidence: 99%