Endoscopic radial artery harvest: a new approach

Although early attempts to use the radial artery (RA) as a conduit for cardiac revascularization met with disappointing results, recent data have shown the RA to achieve very good short-term patency as well as promising mid-term patency results. The recent increase in the frequency of coronary reoperations, with their limited options for vascular conduits, has also stimulated an interest in the RA graft. The success of minimally invasive vein harvesting techniques encouraged us to develop a minimally invasive technique for harvesting the RA from the forearm, which is reviewed in this article.

The endoscopic harvest technique was employed on more than 120 nonselected patients at our facility over a 12-month period. The procedure involved exposure of the RA under direct visualization and without direct manipulation, using an endoscopic dissector and harmonic shears. Side branches of the RA were isolated and divided, and the vessel was removed and side branch occlusion verified. The harvested RA was then prepared for the revascularization surgery.

The patients who underwent the procedure showed no evidence of graft spasm or occlusion in the immediate postoperative period. Patients also preferred the small endoscopic incision to the full forearm incision of the "open" technique.

Our experience indicates that endoscopic radial artery harvesting is a safe technique that achieves good short-term patency results and improved patient satisfaction. Evaluation of long-term vessel integrity is needed, and a comparison of the minimally invasive and the open technique has been initiated.