Neurologic sequelae of the donor arm after endoscopic versus conventional radial artery harvesting

Bleiziffer, Sabine; Hettich, Ina; Eisenhauer, B; Ruzicka, Daniel J.; Voß, Bernhard; Bauernschmitt, Robert; Lange, Rüediger

doi:10.1016/j.jtcvs.2008.02.067

Cited by 22 publications

(18 citation statements)

References 29 publications

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“…The risk of SBRN is comparable in both techniques due to its anatomical proximity to RA (ref. 22 ). Functional and histological assessment of conduits taken endoscopically and conventionally revealed no differences in alteration of vasoreactivity or endothelial integrity between groups in prospective randomized trial 23 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic radial artery harvesting for coronary artery bypass grafting. A single center evolving experience

Šimek¹,

Marcián²,

Gwozdziewicz³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. We sought to evaluate our experience with endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). Methods. From October 2005 to June 2010, 50 patients who underwent endoscopic radial artery harvesting for an elective CABG were prospectively assessed for harvesting characteristics, complications, postoperative and mid-term outcomes.Results. There were 34 (68%) males and 16 (32%) females, average age 60.8±9.2 years. All but two RA grafts (96%) were successfully harvested endoscopically. Mean harvesting time was 46.2±9.3 min and mean length of harvested grafts was 23.4±2.2 cm. In the post-operative period there were no wound-healing complications; residual forearm edema was recorded in 6 patients (12%) and peripheral neuropathy in 4 patients (8%). At 3 months after the surgery, peripheral neuropathy and residual edema persisted in 2 patients (4%). A significant drop of overall harvesting time (56.2± 18.6 vs. 38.6±8.6 min, P<0.05) and forearm ischemia time (41.8±12.7 vs. 24.2±3.2 min, P<0.01) was found between first and last ten cases in the group. Conclusion. Endoscopic radial artery harvesting was associated with low risk of post-harvesting complications and most of these disappeared within a 3 months follow-up. However, there was a significant learning curve.

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Section: Discussionmentioning

confidence: 99%

Endoscopic radial artery harvesting for coronary artery bypass grafting. A single center evolving experience

Šimek¹,

Marcián²,

Gwozdziewicz³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The incidence of neurological disturbances following radial artery harvesting has been reported to occur within an extremely wide range, that is, from 0 to 86% [19][20][21]. The mechanisms of nervous injury following radial artery harvesting can be multifactorial: direct damage to the nerves in the forearm, the use of cautery and mechanical traction [20].…”

Section: Key Pointsmentioning

confidence: 99%

“…The mechanisms of nervous injury following radial artery harvesting can be multifactorial: direct damage to the nerves in the forearm, the use of cautery and mechanical traction [20]. However, there are conflicting results to date with respect to the incidence of neurological disturbances following endoscopic radial artery harvesting: Patel et al [12] reported a considerable reduction of neurological complications with the minimally invasive approach, whereas Bleiziffer et al [19] found a relatively high percentage of patients suffering from paraesthesia/sensory numbness also with the endoscopic technique. However, there are conflicting results to date with respect to the incidence of neurological disturbances following endoscopic radial artery harvesting: Patel et al [12] reported a considerable reduction of neurological complications with the minimally invasive approach, whereas Bleiziffer et al [19] found a relatively high percentage of patients suffering from paraesthesia/sensory numbness also with the endoscopic technique.…”

Section: Key Pointsmentioning

confidence: 99%

Endoscopic vessel harvesting

Bisleri

Moggi²,

Muneretto³

2013

Current Opinion in Cardiology

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Endoscopic conduit harvesting is a well-tolerated and effective procedure. The majority of scientific reports depicted that the minimally invasive approach does not compromise the quality of the harvested conduits and therefore does not lead to a higher incidence of graft failure or cardiac-related events in the mid-long term. The endoscopic technique should be the approach of choice for saphenous vein and radial artery procurement in CABG surgery; recent technical and technological advancements could further improve outcomes.

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“…Other studies have shown the same, including a significant decrease in other complications such as haematomas and infections [16-18]. So far, only one randomised clinical trial dealing with postoperative neurological deficits and pain has been published [19].…”

Section: Introductionmentioning

confidence: 90%

“…Most use non-specific neurological examinations and others only rely on questionnaires [24]. The most specific examination procedure seems to be used by Bleiziffer et al, who assessed the muscle strength, deep tendon reflexes, temperature, pain, and touch sensation [18]. …”

Section: Introductionmentioning

confidence: 99%

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

Carranza

Ballegaard

Werner

et al. 2014

Trials

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BackgroundCoronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique.Methods/DesignThe NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory.Trial registrationClinicalTrials.gov identifier: NCT01848886.Danish Ethics committee number: H-3-2012-116.Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838.

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Neurologic sequelae of the donor arm after endoscopic versus conventional radial artery harvesting

Cited by 22 publications

References 29 publications

Endoscopic radial artery harvesting for coronary artery bypass grafting. A single center evolving experience

Endoscopic radial artery harvesting for coronary artery bypass grafting. A single center evolving experience

Endoscopic vessel harvesting

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

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