Radial artery harvest using endoscopic techniques

Endoscopic vessel harvest for coronary artery bypass conduit has become a routine procedure. With the advancement of endoscopic equipment, radial arteries can be safely harvested with excellent cosmetic results.

One hundred consecutive patients undergoing coronary artery bypass grafting underwent endoscopic radial artery harvest without complications requiring intervention. The vessel was accessed through a 3-cm long, longitudinal incision performed several millimeters medial to the palpated artery to avoid the lateral antebrachial cutaneous nerve. Commercially available endoscopic retractors, using ultrasonic or direct-current shears, were used to ligate side branches and mobilize the pedicled artery and satellite veins. Ligation was performed with clips at the wrist, endo-loops proximally, and endoshears for transection.

Patient age ranged from 42 to 88 years; 70% of the patients were men, and 26% were diabetic. Le f t radial arteries were preferentially harvested. All arteries were used and no further conduit was needed because of inadequate length. In 2 patients subcutaneous hematomas formed postoperatively and resolved without exploration. Although some thenar dysthesia was present in 14 patients, no permanent neurovascular injuries occurred. There were no infections, although skin edges did get traumatized from the retractor.

Radial arteries can be harvested in a reproducible, safe, and efficient manner wi th less morbidity and better patient satisfaction.