Use of extrafascially harvested radial artery for coronary artery revascularization: Technical considerations

Background: The use of the radial artery for coronary artery revascularizat ion was abandoned due to its tendency for. spasm; the revival was attribute d to improved harvesting technique as well as the use of calcium channel bl ockers. Methods: Between February 1996 and June 1997, the radial artery gra ft was used in 77 of 89 consecutive patients undergoing coronary artery byp ass graft surgery. Only the patients with positive Alien's test or forearm deformity were denied the use of the radial artery. We used an extrafascial , no-touch technique using low-strength electrocautery for harvesting the r adial artery. Calcium channel blockers were not used in any of these patien ts. Results: There were no early deaths. No patient sustained perioperative myocardial infarction or required intra-aortic balloon pump. Only one pati ent required inotropic agents. Three noncardiac late deaths occurred during the follow-up of 6 to 24 months. No early or late ischemic or functional f orearm disability was reported in any of the patients. Conclusions: The rad ial artery is easy to harvest and safe to use routinely. When harvested ext rafascially, diltiazem infusion may not be necessary. Maximal arterial-glob al revascularization using the left internal thoracic artery-to-left anteri or descending coronary artery and radial artery-to-circumflex artery system may improve the early and long-term results.