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J Thorac Cardiovasc Surg 2008;136:681-687
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Neurologic sequelae of the donor arm after endoscopic versus conventional radial artery harvesting

Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany

Received for publication October 8, 2007; revisions received January 28, 2008; accepted for publication February 18, 2008.

^_* Address for reprints: Sabine Bleiziffer, MD, Clinic for Cardiovascular Surgery, German Heart Center Munich, Lazarettstr. 36, 80636 Munich, Germany. (Email: bleiziffer{at}dhm.mhn.de).

Objective: Endoscopic radial artery harvesting remarkably improves cosmetic results after coronary artery bypass surgery. The aim of this study was to investigate neurologic sequelae of the donor arm compared with those occurring after the conventional harvesting technique.

Methods: Fifty-three patients who had undergone endoscopic radial artery harvesting were followed up 1 year after the coronary artery bypass operation by means of questionnaire analysis and clinical neurologic investigation (ENDO group). Fifty-three patients who had conventional radial artery harvesting during the same time frame served as control subjects (OPEN group).

Results: Postoperative wound revision was required in 4 patients of the OPEN group (P = .045 vs the ENDO group). Neurologic symptoms of the donor arm were present in 22 (OPEN group) versus 34 (ENDO group) patients (P = .020): a lesion of the superficial radial nerve was shown in 12 (OPEN group) versus 24 (ENDO) patients (P = .014), and a lesion of the lateral antebrachial cutaneous nerve occurred only in the control group in 12 patients (P < .001). Paraesthesia without impaired sensibility was present in 3 (OPEN group) versus 10 (ENDO group) patients (P = .038). Clinical investigation revealed that temperature, pain, and touch sensation, as well as spatial discrimination, were equally impaired in symptomatic patients, whereas vibration sensation was not affected.

Conclusion: After endoscopic radial artery harvesting, impaired sensibility in the region of the superficial radial nerve and paresthesia are more frequent than after the open procedure. However, in contrast to the sequelae of the open procedure, wound revision and injury of the lateral antebrachial cutaneous nerve did not occur. Because of the excellent cosmetic results and avoidance of wound complications, we have opted to use endoscopic radial artery harvesting as the technique of choice, despite the higher incidence of sensory disturbances.