Radial Artery Useful for CABG, Without Undue Effects on Hand Function

The radial artery may be used safely and effectively as a graft for coronary artery bypass surgery, and the procedure is associated with low morbidity in relation to functional hand status.

Early results using the radial artery as a conduit were disappointing, explain the authors of a report in the November Annals of Thoracic Surgery, but the advent of more careful selection and harvesting has brought a revival

Dr. Zile Singh Meharwal and colleagues from Escorts Heart Institute and Research Centre in New Delhi, India reviewed their experience with radial artery harvesting in 3977 patients (258 women and 3719 men) undergoing coronary artery bypass grafting between 1996 and 2000.

No patient experienced acute ischemic injury of the hand, the authors report, though nearly a quarter of the patients complained of numbness or paresthesia at the time of discharge.

Sixteen patients had acute wound infections that required antibiotic treatment, the report indicates, and there were 15 late infections that responded to antibiotics and local wound dressing.

Numbness and paresthesia continued beyond 3 months in 242 (6.5%) of patients and beyond 6 months in 46 (1.22%) patients, the researchers note, but all but 9 patients were using the hand normally within 3 months of surgery.

At a mean 18 months after surgery, 92.3% of radial grafts were patent, the investigators say, compared with 96.0% of internal mammary artery grafts and 76.6% of vein grafts.

“The radial artery should be considered as an important conduit in the armamentarium of surgeons,” Dr. Meharwal told Reuters Health. “The functional results of hand after its use are good.”

“The assessment of the hand collateral circulation is very important before harvesting,” Dr. Meharwal advised. “Meticulous harvesting and handling of radial artery will give good results.”

Ann Thorac Surg 2001;72:1557-1561.