Open Technique for Radial Artery Harvesting

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After painting and draping, the radial artery pulsation between the tendons of the flexor carpi radialis and brachioradialis muscles, the brachial artery pulsation medial to the biceps brachii tendon, and the antecubital fossa were marked to delineate the incision. A small incision was then made at the distal end and expanded with electrocautery. A self-retaining retractor was placed, and dissection continued until the radial artery was visualized. At this juncture, the radial artery was examined for caliber and calcification. Gentle palpation over the radial artery showed no calcification. Therefore, the incision was expanded up to the proximal marking line, ensuring that it remained medial to the brachioradialis muscle, and was further expanded with electrocautery. Another self-retaining retractor was placed at the proximal end of the incision to facilitate better visualization.  

The superficial and deep fascia was dissected until the muscle layer was reached. The superficial branch of the radial nerve was visualized just lateral to the radial artery. It was imperative not to injure this branch to avoid postoperative numbness in the hand and lateral three fingers. A vessel loop was passed around the distal end of the radial artery, providing gentle atraumatic traction on the radial artery while avoiding instrumentation. While providing gentle traction through the vessel loop, the radial artery was lifted, and tissue was dissected around it. Branches were visualized, isolated from surrounding tissue, clipped, and cut. Care was taken not to dissect the fascia directly above the radial artery, as it contains the vasa vasorum for the radial artery, and doing so could lead to spasm of the radial artery. Additionally, caution was exercised to avoid cutting into the muscles and to remain in the avascular plane between the brachioradialis and flexor carpi radialis muscles to allow for a bloodless dissection. The radial artery was dissected along its entire length to the bifurcation of the brachial artery. Good pulsations were observed in the radial artery, indicating no signs of spasm. The radial artery was then washed in a warm papaverine solution. The distal end was clipped and cut, confirming good pulsatile blood flow, after which a bulldog was applied. Right-angle forceps were applied to the proximal end and divided. The harvested radial artery was placed in the papaverine solution, and the proximal stump was transfixed with 4-0 polypropylene sutures. 

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