Radial artery harvest comparable to saphenous vein harvest for cardiac bypass

Image: PD 

1. Although operative site pain was higher at three months in patients following radial artery harvest compared to saphenous vein, at twelve months there was no statistically significant difference. 

2. Following a radial artery harvest operation, patients recovered their grip strength and were able to perform at pre-surgery levels on a fine motor task (9-hole peg test). 

Evidence Rating Level: 2 (Good)            

Study Rundown: This post hoc analysis of the VA Cooperative Studies Program (CSP) compared outcomes of a radial artery harvest versus the saphenous vein, the more conventional harvest site. The primary outcome of the trial was angiographic graft patency at one year after coronary artery bypass graft (CABG). Previously, radial artery grafts were thought to stay patent longer over time, but there has been little evidence to support this claim. The authors demonstrated that postoperative radial artery harvest outcomes are similar to saphenous vein in terms of long-term wound site pain, grip strength, or dexterity. Though the original VA CSP is clearly well-designed with standardized procedures and good follow-up, this study is limited by its post hoc nature. Additionally, longer follow-up would be necessary to rule out complications such as scarring that could affect hand dexterity and may not be apparent until years after surgery.

Click to read the study in JAMA Surgery

Relevant Reading: Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial

In-Depth [randomized controlled trial]: This study is a post hoc analysis of the VA CSP 474 trial. The authors compared pain, strength, and dexterity outcomes in 337 patients who underwent traditional saphenous vein harvest to 80 patients whose radial artery was used for grafting. Pain scores were adjusted based on the severity of pain in the non-operated limb, age, endoscopic vs. open vein harvesting and cardiovascular comorbidities. On a pain scale from 1 to 100, three month pain scores were significantly higher in the radial artery group (17.5 vs. 13.4 in saphenous vein group, p<0.001). At one year, the difference was resolved (13 vs. 15.2, p=0.07). Grip strength and 9-peg test performance indicating dexterity was unchanged at both follow-up points (p>0.05).

By Asya Ofshteyn and Chaz Carrier

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