Endoscopic Radial Artery Harvesting

Introduction
The radial artery has been considered a conduit for coronary surgery for more than 30 years. Its use has steadily increased over the years, especially in light of the benefits of arterial revascularization. The usual method of harvesting the radial artery has been by an open technique with an incision extending from the wrist to the elbow. In this video, the authors demonstrate the technique for endoscopic radial artery harvest.

Indications
The authors’ practice is to consider using the radial artery as the second conduit of choice in patients below 70 years of age, and the graft usually goes to either the obtuse marginal artery or to the right coronary artery. The authors use the radial if the target is more than 1.5 mm and has a proximal tight lesion of more than 70% for the circumflex and more than 90% for the right coronary artery.

Procedure
Usually the nondominant arm is used. The arm is kept extended at right angles to the table for the open technique. The authors use the Maquet Vasoview 7 System™ and a zero degree Karl Storz™ camera system. The incision is made at the wrist level in 2 cm. After creating a space with the dissector on top of the artery, the trocar is introduced. Then with the help of CO2 insufflation, the space is created all around the radial artery pedicle using the dissector near the elbow. Then with the help of the bi-sector tool and the C ring, the branches are cauterized and cut. The proximal end is then divided between clamps and the radial artery pedicle is brought out through the wrist incision. After clipping the branches on the back table, the radial artery is kept in a preservative solution at room temperature until it is ready for use.  

Reference

Navia JL, Olivares G, Ehasz P, Gillinov AM, Svensson LG, Brozzi N, et al. Endoscopic radial artery harvesting procedure for coronary artery bypass grafting. Ann Cardiothorac Surg. 2013;2(4):557-564.

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