Endoscopic radial artery harvesting without the scar

Endoscopic radial artery harvesting for coronary artery bypass grafting yields a better cosmetic result and improved patient satisfaction based on the first 300 patients to have the procedure at Lenox Hill Hospital in New York City. Standard removal of a radial artery is done through an incision the length of a patient’s arm. Because of the considerable scar, they’ve noticed a lot of patient dissatisfaction with this procedure, it was reported at the annual meeting of the Society of Thoracic Surgeons.

In the endoscopic approach a 2-3 to 3—mm incision is made just proximal to the radial styloid prominence in the patient’s nondominant forearm. After the ulnar artery is identified, the radial artery is transected 1-2 cm from the brachial artery and removed through the wrist incision. A bandage is placed over the incision, and the forearm is wrapped to prevent hematoma formation in the first 24-48 hours. The scar is small enough to be hidden by a watchband, according to a cardio- thoracic and vascular surgeon at Lenox Hill Hospital. The radial artery is prepared for grafting at a separate table in the operating room. The conduit length varied from 18 to 24 cm depending on the length of the patient’s arm. The mean patient age was 62 years, and 23 percent were women. All 300 radial arteries were acceptable and were used for grafting. With experience, the harvesting procedure is now completed in 15-20 minutes. One patient’s ulnar artery was inadvertently clipped and was repaired without sequelae. Postoperative complications included two subcutaneous hematomas that resolved without drainage and five cases of incisional cellulites that were treated with oral antibiotics. The most common adverse outcome was numbness in the dorsal thenar area, reported by 26 participants (percent) no patient experienced in-hospital myocardial infarction or required a reintervention. Endoscopic radial artery harvesting leads to improved angiographic patency and clinical results. It is a technically achievable and safe procedure win minor, infrequent complications.

One doctor predicted the improved patient satisfaction and cosmetic results from endoscopy would drive an increased use of radial artery harvesting for bypass surgery. Development of arm specific endoscopic equipment may decrease neurologic complications and make the procedure easier to perform. They have a study underway to continue evaluating the safety and long-term outcomes of endoscopic radial artery harvesting.