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Robinson NB, Tatoulis J, Gaudino M. Is endoscopic radial artery harvesting open for business? J Card Surg 2021; 35:2155-2157. [PMID: 33448470 DOI: 10.1111/jocs.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With the resurgence of the radial artery in coronary artery bypass grafting, the debate on the optimal harvesting technique continues. Here, we comment on a randomized series in which the authors conclude that endoscopic harvesting techniques offer the benefit of improved cosmetic outcomes and decreased neurological complications with comparable graft-related outcomes when compared with open harvesting. We conclude that although this study is well designed and conducted, there are several areas of concern including surgical technique and statistical power.
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Affiliation(s)
- N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - James Tatoulis
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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Zhang J, Cheng Y, Chen D, Zhang F, Duan S, Chen L, Chen C, Sang Y, Shi L, Yang W, Chen Y. Is the result of modified Allen’s test still accurate after endoscopic thoracic sympathectomy? J Thorac Dis 2020; 12:696-704. [PMID: 32274135 PMCID: PMC7139016 DOI: 10.21037/jtd.2019.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The radial artery (RA) is increasingly being used for coronary artery bypass grafting (CABG). Endoscopic thoracic sympathectomy (ETS) has been shown to block innervation of sympathetic nerves of upper limbs, which reduces sweating of hands and dilates blood vessels. The modified Allen’s test (MAT) is one of the commonest methods of assessing collateral arm flow prior to RA harvest, though it has limitations. However, the reliability of MAT after ETS remains unclear. We therefore investigated the effects of ETS on the results of MAT. Methods A retrospective cohort study was conducted on 164 consecutive Chinese patients with palmar hyperhidrosis who underwent ETS between January 2016 and January 2019. The medical records were reviewed concerning the ultrasound examination and MAT results of their RAs and ulnar arteries (UAs) in both forearms before and after ETS. Results The performance of ETS significantly increased the diameter of the right RA from 2.731±0.122 to 3.102±0.114 mm in men and from 2.347±0.074 to 2.915±0.162 mm in women. Similar effects of ETS were observed in expanding the diameters of the left RA and the UA. Meanwhile, there was no significant effect of ETS on systolic blood pressure (BP) and heart rate (HR). Overall, retesting of patients following ETS with a preoperative positive MAT result revealed a transition to a negative result. Conclusions ETS was effective in dilating RA in both men and women, which could lead to a false negative preoperative MAT result. Patients should be questioned about their history of ETS if their RAs are to be harvested for CABG. More studies are warranted to evaluate the safety of RA as a coronary artery graft after ETS.
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Affiliation(s)
- Jiaheng Zhang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Yuanjun Cheng
- Department of Cardiothoracic Surgery, People’s Hospital of Chizhou, Chizhou 247100, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai 200433, China
| | - Fuquan Zhang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Shanzhou Duan
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Lei Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai 200433, China
| | - Yonghua Sang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Li Shi
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Wentao Yang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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Virk HUH, Lakhter V, Ahmed M, O' Murchu B, Chatterjee S. Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: a Literature Review. Curr Cardiol Rep 2019; 21:36. [PMID: 30903300 DOI: 10.1007/s11886-019-1112-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Coronary artery bypass grafting is a preferred strategy for complete coronary revascularization in patients who have multi-vessel coronary artery disease, left ventricular dysfunction, and/or diabetes. Both arterial (internal thoracic artery/radial artery) and venous grafts are utilized to bypass the obstruction in native vessels. Despite having radial arterial grafts as a preferred second conduit for bypass, venous grafts are more commonly used. RECENT FINDINGS We review the existing literature and report the preferred conduit based on a recently published meta-analysis of 6 randomized controlled trials. The analysis concluded that radial artery grafts are associated with fewer adverse cardiac events and better graft patency at 5 years of follow-up. Although saphenous vein grafting is the most commonly used conduit in addition to ITA, current data suggests that total arterial bypass (using RA conduit in addition to ITA) may be the better strategy. Both the US and European consensus guidelines advocate for the use of arterial over SV grafting for most patients.
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Affiliation(s)
- Hafeez Ul Hassan Virk
- Department of Cardiovascular Diseases, Einstein healthcare Network, Philadelphia, PA, USA
| | - Vladimir Lakhter
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Muhammad Ahmed
- Department of Cardiology, Ochsner Health system, New Orleans, LA, USA
| | | | - Saurav Chatterjee
- Division of Cardiology, Hoffman Heart Institute, St Francis Hospital, Hartford, CT, USA.
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Upper Extremity Complications and Concerns in Patients With Cardiac Disease. J Hand Surg Am 2016; 41:470-2. [PMID: 26723477 DOI: 10.1016/j.jhsa.2015.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 02/02/2023]
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Carranza CL, Ballegaard M, Werner MU, Hasbak P, Kjær A, Kofoed KF, Lindschou J, Jakobsen JC, Gluud C, Olsen PS, Steinbrüchel DA. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial. Trials 2014; 15:135. [PMID: 24754891 PMCID: PMC4033613 DOI: 10.1186/1745-6215-15-135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
Background Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. Methods/Design The NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group. The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively. We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory. Trial registration ClinicalTrials.gov identifier: NCT01848886. Danish Ethics committee number: H-3-2012-116. Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838.
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Affiliation(s)
- Christian L Carranza
- Department of Cardio-thoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Wu HB, Hu R, Wang ZW, Hu ZP, Li LC, Wu ZY, Xu P, Deng HP. Endoscopic radial artery harvesting does not compromise graft patency for coronary artery bypass graft: a meta analysis of 2782 patients. Heart Lung Circ 2014; 23:1084-90. [PMID: 24796680 DOI: 10.1016/j.hlc.2014.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/07/2013] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Endoscopic radial artery harvesting is a favourable harvesting technique which provides excellent cosmetic result and low incidence of incision related complications, however the impact of this technique on graft quality is less well-explained. We sought to evaluate the impact of harvesting technique on graft patency and relevant clinical outcomes in patients undergoing coronary artery bypass graft (CABG). METHOD A systematic literature search was conducted to identify publications containing comparisons between different sampling skills in CABG, data was extracted and analysed with Revman, Downs and Black score was applied to evaluate the methodological quality of included studies. RESULT Ten studies containing 2782 patients were undertaken, the quality was generally acceptable. Pooled analysis results indicate endoscopic radial artery harvesting was associated with a lower incidence of wound infection and a similar incidence of haematoma formation compared with open harvesting. The difference in graft patency and all-cause mortality was insignificant between two cohorts. CONCLUSION Endoscopic radial artery harvesting is a safe technique and provides equivalent graft patency as compared with open harvesting, further investigation is required to confirm the aforementioned conclusion and evaluate the impact of harvesting technique on hand sensory and motor function.
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Affiliation(s)
- Hong Bing Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Rui Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhi Wei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Zhi Peng Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Luo Cheng Li
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhi Yong Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Peng Xu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Hong Ping Deng
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Baikoussis NG, Papakonstantinou NA, Apostolakis E. Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics. J Cardiol 2014; 63:321-8. [PMID: 24525045 DOI: 10.1016/j.jjcc.2013.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/01/2013] [Accepted: 11/14/2013] [Indexed: 10/25/2022]
Abstract
Radial artery (RA) is the most popular arterial graft after the left internal thoracic artery in both low- and high-risk patients undergoing coronary artery bypass grafting. Various arterial grafts such as the right internal thoracic artery, the right gastroepiploic artery, and the inferior epigastric artery have also gained ground over the past 30 years because of the intimal hyperplasia and atherosclerosis of the saphenous vein leading to late graft occlusion. In this review article we would like to present the utility of the RA as a graft, focused mainly on its structural and biological characteristics.
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Affiliation(s)
| | | | - Efstratios Apostolakis
- Department of Cardiac Surgery, Ioannina University Hospital, School of Medicine, Ioannina, Greece
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Zhu YY, Hayward PA, Hadinata IE, Matalanis G, Buxton BF, Stewart AG, Hare DL. Long-term impact of radial artery harvest on forearm function and symptoms: A comparison with leg vein. J Thorac Cardiovasc Surg 2013; 145:412-9. [DOI: 10.1016/j.jtcvs.2012.01.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 12/20/2011] [Accepted: 01/04/2012] [Indexed: 11/25/2022]
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Ito N, Kuwahara G, Sukehiro Y, Teratani H. WITHDRAWN: Endoscopic Radial Artery Harvesting: Long-Term Results and Graft Patency Rate. Ann Thorac Surg 2012:S0003-4975(12)01336-7. [PMID: 22840603 DOI: 10.1016/j.athoracsur.2012.05.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/25/2012] [Accepted: 05/31/2012] [Indexed: 11/29/2022]
Abstract
This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy. This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.
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Affiliation(s)
- Nobuhisa Ito
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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Ito N, Tashiro T, Morishige N, Iwahashi H, Nishimi M, Hayashida Y, Takeuchi K, Minematsu N, Kuwahara G, Sukehiro Y. Endoscopic Radial Artery Harvesting for Coronary Artery Bypass Grafting: The Initial Clinical Experience and Results of the First 50 Patients. Heart Surg Forum 2009; 12:E310-5. [DOI: 10.1532/hsf98.20091080] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Bleiziffer S, Hettich I, Eisenhauer B, Ruzicka D, Voss B, Bauernschmitt R, Lange R. Neurologic sequelae of the donor arm after endoscopic versus conventional radial artery harvesting. J Thorac Cardiovasc Surg 2008; 136:681-7. [DOI: 10.1016/j.jtcvs.2008.02.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 01/28/2008] [Accepted: 02/18/2008] [Indexed: 10/21/2022]
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12
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Nishida S, Kikuchi Y, Watanabe G, Takata M, Ito S, Kawachi K. Endoscopic radial artery harvesting: patient satisfaction and complications. Asian Cardiovasc Thorac Ann 2008; 16:43-6. [PMID: 18245705 DOI: 10.1177/021849230801600111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endoscopic radial artery harvesting was recently introduced to reduce the morbidity associated with conventional open harvesting and improve cosmetic outcomes. From January 2004 through December 2006, 25 radial arteries were harvested endoscopically from 25 patients using the VasoView endoscopic system. Bilateral radial arteries were harvested from 6 patients by both the endoscopic and open techniques, and postoperative patient satisfaction was assessed using a visual analogue scale. Mean harvesting time was 61.9 +/- 16.0 min (range, 44-105 min), and mean harvested conduit length was 16.8 +/- 2.0 cm (range, 15-19 cm). Objective dorsal thenar numbness remained in 2 patients (8%); none complained of forearm numbness. All patients expressed marked satisfaction with the endoscopic technique and the small incision. Patient satisfaction was significantly higher with the endoscopic technique than with the open technique (visual analogue scale of 9 vs 5). Postoperative angiography revealed occlusion of a graft that had been anastomosed to a small diagonal branch. The overall graft patency was 96.6%. Endoscopic radial artery harvesting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.
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Affiliation(s)
- Satoru Nishida
- Division of Cardiac Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Tokyo 160-0023, Japan.
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Langer DJ, Vajkoczy P. ELANA: Excimer Laser-Assisted Nonocclusive Anastomosis for extracranial-to-intracranial and intracranial-to-intracranial bypass: a review. Skull Base 2005; 15:191-205. [PMID: 16175229 PMCID: PMC1214705 DOI: 10.1055/s-2005-872048] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ELANA, excimer laser-assisted nonocclusive anastomosis, is a technique using an excimer laser/catheter system for intracranial bypass surgery of the brain. The technique has been developed over the past 12 years by Tulleken and colleagues at UMC Utrecht in The Netherlands for treatment of primarily untreatable giant aneurysms. We review here the emergence of transplanted conduit bypass as a valuable technique for managing these lesions and the subsequent development of ELANA bypass. The ELANA technique allows the operating surgeon to perform an extracranial-to-intracranial or intracranial-to-intracranial bypass using a transplanted large caliber conduit without occlusion of the recipient artery, thus eliminating intraoperative ischemic insult related to temporary occlusion time. We describe the ELANA technique, illustrate it with intraoperative photos, and review the relevant literature. ELANA is shown to be safe; we discuss its advantages over conventional techniques.
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Affiliation(s)
- David J Langer
- Department of Neurosurgery, St. Luke's-Roosevelt Hospital Medical Center, New York, New York, USA.
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