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J Thorac Cardiovasc Surg 2001;121:951-956
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Radial artery harvesting for coronary bypass operations: Neurologic complications and their potential mechanisms

Timothy A. Denton, MDa, Luca Trentoa, Myles Cohen, MDb, Robert M. Kassa, Carlos Blanche, MDa, Sharo Raissi, MDa, Wen Cheng, MDa, Gregory P. Fontana, MDa, Alfredo Trento, MDa

From the Divisions of Cardiothoracic Surgery, Cardiology,a and Orthopedic Surgery,b Cedars-Sinai Medical Center, Los Angeles, Calif.

Received for publication July 20, 2000. Revisions requested Sept 21, 2000; revisions received Oct 3, 2000. Accepted for publication Nov 8, 2000. Address for reprints: Timothy A. Denton, MD, Room 6215, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (E-mail: denton{at}cshs.org).

Objectives: We sought to determine the incidence of self-reported neurologic hand complications after radial artery harvest for coronary artery bypass grafting.
Methods: Between February 20, 1996, and December 31, 1999, 615 patients underwent coronary bypass operations with radial arteries. A scripted telephone interview was performed, collecting data on perceived thumb weakness and sensation abnormalities in the distribution of the radial nerve in 560 patients. The average time to follow-up interview was 14.5 ± 9 months.
Results: Neurologic complications were reported in 30.1%, decreased thumb strength in 5.5%, and any sensation abnormality in 18.1% of patients. There was a high rate of symptom improvement over an average of 8.7 ± 7.5 months, such that only 12.1% of patients reported symptoms without any improvement. Associations between thumb weakness and sensory abnormalities imply median nerve damage in some patients. There were statistically significant associations between neurologic complications and diabetes, peripheral vascular disease, elevated creatinine levels, smoking, and number and site of radial artery harvest.
Conclusions: The overall rate of self-reported neurologic complications after radial artery harvest was higher than previously reported. These symptoms may be attributable to radial and median nerve injury caused by trauma and devascularization. These data have important implications not only in attempting to improve harvesting techniques but also in guiding informed consent before coronary artery bypass grafting.




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