Hand Funciton following Radial Harvest of CABG

hi there,

Presently looking at Hand Function following Radial Artery Harvesting in CABG as a part of academic exercise.

would be interested any one out with experince of dealing patient with Radial Artery Harvest.

any comment invited

with thanks
Bhvuensh Shah

I would really like to know why the surgeon decided to use the radial artery! why not the good old harvesting from the pecs or legs?8o

the old technique with Sephanous vein (SV) had disadvantage of limited long term patency which coincides with recurrence of the ichemic events like angina and MI in patients even after CABG. Advance atherosclerotic desease is confirmed angiographically in SV graftin symtomatic patients with CABG. Arguably a graft from low pressure system shows accelerated desease process then graft from high pressure system.

As alternative is use of Left and Right Internal Mammary artery (LIMA and RIMA)(otherwise known as internal thoracic artery (ITA)), and subsequently improved long term survival benifit, leading to the rational of total arterial revascularisation. Presently standard procedure involves LIMA-LAD (Left anterior Descending artery) graft with other vessels grafted by either SV, RIMA or Radial.

Bilateral IMA had certain disadvantages like poor sternal healing etc. and not recommanded in very obese and diabetic patient to name few.

Radial artery provides alternative graft and harvested only in patient with intact superficial palmer arch, confirmed by modified Allen's test and colour dopler preoperatively and back bleeding intraoperatively.

Hope u find usefull

Cheers
Bhuvensh Shah

Thanks Bhuvensh for your excellent, concise update and eductional posting. The radial artery part to all this is new to me as it was not taugt when I was an undergrad. LIMA was typical as was the saphenour vein from the leg.

It is great to read simple, informative postings :D

Dear Bhvuensh Shah
as long as i did work with CABG patients in my career i have seen 2 patients with anomalies post radial artery harvesting , one was a complication... septicemia related and teh other one was related to sensory loss at the area of harvest and a motor: praxic picture that was treated like any other neuropraxia after the harvest site healed up.. the reason that was sited was an intra op handling of the nerve.
i other wise have never come across any other anomalie post radial harvesting during this career of mine.
Id also like to add to your paragraph on the lima-rima grafts that; they also do use many other arterial harvests like the gastro-epiploic artery and teh greater omental artery also the splenic arteries are used ... toname a few... im sure teh surgeons must be using many more for an option if the radial atrey is not availible due to some technical reason.
hope you do find some more on this toipc... do keep us a well updated.
kripag

Thanks kripag for valuable feedback,

I'm looking forward for the specific incidence of the complication (Hand dyfuction resulting from neurological leadig to motor or sensory, musculoskeletal, or vascular)

can you confirm exactly what is the incidence of it.

regards Bhuvnesh Shah

I believe following a radial artery graft as choice for CABG ,we need to concentrate on Pronation and Supination mvements particularly the end range and also movements of thumb.there have been patients with complaints of (initial stage )numbness over the radial side of wrist.

hi bhuvnesh,

i dealt with radial artery graft patients on daily basis. What I could find was neurological impairments, numbness and tingling, At times transient and at times persistent. May be because of nerve bite in suture. Can you please let me know your variables to determine hand functions or in simple words, how r u measuring hand functions? Is it hand strength with dynamometer. please post some references or necessary links.

thanks