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Functional status of the hand after radial artery harvesting: results in 3,977 cases
1Escorts Heart Institute and Research Centre, New Delhi, India. meharwal@hotmail.com
Insights
Coronary artery bypass grafting using the radial artery shows low hospital mortality and good early to midterm results. This conduit offers a viable alternative to the saphenous vein, with minimal impact on hand function.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Outcomes
Background:
- Increasing use of radial artery grafts in coronary artery bypass grafting (CABG).
- Comparison of radial artery versus saphenous vein conduits.
- Assessment of hand function post-radial artery harvesting.
Purpose of the Study:
- To analyze early and midterm outcomes of CABG using radial artery grafts.
- To evaluate the functional status of the hand after radial artery harvesting.
- To determine the safety and efficacy of radial artery as a CABG conduit.
Main Methods:
- Radial artery used in 3,977 CABG patients (Dec 1996-Nov 2000).
- Preoperative Modified Allen's test and intraoperative pulse oximetry for hand collateral circulation assessment.
- Follow-up via outpatient clinics, questionnaires, and angiography at 18 months.
Main Results:
- Hospital mortality: 0.8%; perioperative myocardial infarction: 1.3%.
- No acute ischemic injury of the hand; 94% complete follow-up.
- Radial artery patency: 92.3% at 18 months; hand numbness/paresthesias in 6.5%/3% post-3 months.
Conclusions:
- Radial artery is a safe and effective conduit for CABG with low morbidity.
- Good functional outcome of the hand is achieved after harvesting.
- Radial artery is a suitable alternative conduit after the internal mammary artery.
Background:
The radial artery is being used as a conduit of choice over saphenous vein with increasing frequency. We analyzed early and midterm results of coronary artery bypass grafting using radial artery as one of the conduits. The functional outcome of the hand after radial artery harvesting was analyzed.
Methods:
The radial artery was used in 3,977 patients undergoing coronary artery bypass grafting between December 1996 and November 2000. Modified Allen's test was performed preoperatively in the ward and pulse oxymetry was used in the operating theater to assess the collateral circulation of the hand. A total of 4,172 anastomoses were performed using a radial artery. The patients were followed up at regular intervals in the outpatient clinic or were sent questionnaires. The functional results of the hand were assessed. Follow-up angiography was performed in 104 patients at a mean of 18 months.
Results:
The hospital mortality was 0.8%. Perioperative myocardial infarction occurred in 1.3% of patients. The average number of grafts was 3.12. No patient had acute ischemic injury of the hand. Follow-up was complete in 94% of patients. Late infection developed in 0.4% of patients. Numbness and paresthesias continued in 6.5% and 3% patients, respectively, after 3 months. The patency rate of the radial and left internal mammary artery was 92.3% and 96.0%, respectively, at a mean of 18 months.
Conclusions:
Use of radial artery for coronary artery bypass grafting is associated with low morbidity and good functional outcome of the hand. It can be used more frequently as the conduit of choice after the internal mammary artery.
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