Radial artery harvesting for coronary bypass operations: Neurologic complications and their potential mechanisms

Abstract

The overall rate of self-reported neurologic complications after radial artery harvest was higher than previously reported. These symptoms may be attributable to radial and median nerve injury caused by trauma and devascularization. These data have important implications not only in attempting to improve harvesting techniques but also in guiding informed consent before coronary artery bypass grafting.

Mathematical Model of Blood Flow in an Anatomically Detailed Arterial Network of the Arm

“…Indeed, in the absence of the radial artery, an accurate topological description of the arterial vessels would allow to quantify the increase of the blood flow in the remaining ulnar artery as well as to know how the flow rate is distributed to the hand through the superficial and deep palmar arches. Indeed, even some neurological consequences, such as motor abnormalities in different affected areas of the hand, may arise as a consequence of lack of adequate blood flow supply to the surrounding nerves in the regions where the procedure took place [17]. The present model provides the infrastructure to make this quantification possible, being this a matter of current research.…”

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

“…Neuronal injury after RA harvesting can be caused by direct surgical trauma accompanied dissection or overuse of electrocautery, or rather owing to indirect trauma as a consequence of tissue edema, hematoma formation or compartmental forces. This aside, there is also a risk of microvascular malperfusion despite the competency of collateral flow 3,13 . Some sensory loss and/or motor weakness following RA harvesting, mostly in the thumb area, can be perceived very sensitively by the patient, particularly when it produces some hand limitation in regular or work activities even when the impairment was assessed as minor or negligible by the physician 14 .…”

“…The risk of severe post-harvesting complications leading to hand disability as a consequence of hand ischemia or major neuronal trauma is extremely rare if the surgical technique and pre-operative hand collateral blood flow evaluation are carried out properly 2,7,12 . However, neuropathic sensory disturbances in the terminal area of the superficial branch of the radial nerve (SBRN), lateral antebrachial cutaneous nerve (LACN), and sensory part of median nerve (MN) are clinically detectable in 12-51% of cases in the postoperative period and even persist in 8-12% patients 1 year after the surgery 3,13,14 . In addition, in 3-5% of patients had some motor deficit which was caused by injury to the median or the motor branch of the radial nerve 14 .…”

“…Open RA harvesting (ORAH) is considered to be safe and well-accepted for its simplicity and minimal trauma to the graft 2 . However, uninterrupted incision occupying almost the whole length of the volar forearm is associated with some risk of complications, dissatisfaction with the cosmetic result or hypertrophic scar formation, particularly in younger patients and women 3 . In an effort to minimize surgical trauma, endoscopic radial artery harvesting (ERAH) has evolved.…”

Simultaneous endoscopic radial artery and great saphenous vein harvesting for redo coronary artery bypass grafting. A report of two cases

“…Signifi cant reduction in leg-wound complications in the post-operative period as well as in the long-term follow-up were clearly documented, particularly in the presentation of wound-healing risk factors involving obesity, diabetes, peripheral vascular disease and immunosuppression [1][2][3] . ERAH, for the present time not so widely accepted, is associated predominantly with reduction in neurological disturbances whose high incidence following traditional radial artery harvesting has been repeatedly reported 5,6 . Although doubts about the durability of endoscopically harvested conduits exist, several analyses have shown no diff erences in endothelial injury, angiographic outcomes and 5-year event-free survival in comparison with traditionally harvested conduits 1,7 .…”