Related Experiment Videos
Use of extrafascially harvested radial artery for coronary artery revascularization: technical considerations
P Kulshrestha1, L Rao, J L Garb
1Department of Surgery, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
Insights
The radial artery is a safe and effective graft for coronary artery bypass surgery when harvested using an extrafascial technique. This method avoids spasms and improves patient outcomes without calcium channel blockers.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
Background:
- Radial artery use for coronary artery revascularization was previously abandoned due to spasm.
- Revival linked to improved harvesting and calcium channel blockers.
Purpose of the Study:
- Evaluate the safety and efficacy of the radial artery as a coronary artery bypass graft.
- Assess outcomes using an extrafascial, no-touch harvesting technique without calcium channel blockers.
Main Methods:
- Radial artery grafts used in 77/89 patients (Feb 1996-June 1997).
- Exclusion criteria: positive Allen's test or forearm deformity.
- Employed extrafascial, no-touch harvesting with low-strength electrocautery.
- No calcium channel blockers were administered.
Main Results:
- No early deaths, perioperative myocardial infarction, or need for intra-aortic balloon pump.
- One patient required inotropic agents.
- Three late noncardiac deaths during 6-24 month follow-up.
- No reported early or late forearm ischemic or functional disability.
Conclusions:
- Radial artery is easily harvested and safe for routine use.
- Extrafascial harvesting may negate the need for diltiazem.
- Maximal arterial-global revascularization, including radial artery grafts, may enhance outcomes.
Background:
The use of the radial artery for coronary artery revascularization was abandoned due to its tendency for spasm; the revival was attributed to improved harvesting technique as well as the use of calcium channel blockers.
Methods:
Between February 1996 and June 1997, the radial artery graft was used in 77 of 89 consecutive patients undergoing coronary artery bypass graft surgery. Only the patients with positive Allen's test or forearm deformity were denied the use of the radial artery. We used an extrafascial, no-touch technique using low-strength electrocautery for harvesting the radial artery. Calcium channel blockers were not used in any of these patients.
Results:
There were no early deaths. No patient sustained perioperative myocardial infarction or required intra-aortic balloon pump. Only one patient required inotropic agents. Three noncardiac late deaths occurred during the follow-up of 6 to 24 months. No early or late ischemic or functional forearm disability was reported in any of the patients.
Conclusions:
The radial artery is easy to harvest and safe to use routinely. When harvested extrafascially, diltiazem infusion may not be necessary. Maximal arterial-global revascularization using the left internal thoracic artery-to-left anterior descending coronary artery and radial artery-to-circumflex artery system may improve the early and long-term results.