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Original Investigation | Association of VA Surgeons

Consequences of Radial Artery Harvest:  Results of a Prospective, Randomized, Multicenter Trial

William L. Holman, MD1; James E. Davies, MD1; Julia Y. Lin, PhD2; Yajie Wang, PhD2; Steven Goldman, MD3; Faisal G. Bakaeen, MD4; Rosemary Kelly, MD5; Stephen E. Fremes, MD6; Kelvin K. Lee, PhD2; Todd H. Wagner, PhD2; Gulshan K. Sethi, MD3 ; for the VA CSP 474 Investigators
[+] Author Affiliations
1Department of Surgery, Birmingham, Alabama VA Medical Center, Birmingham
2CSP Coordinating Center, VA Palo Alto Health Care System, Mountain View, California
3Department of Medicine and Surgery, Southern Arizona VA Health Care System, Tucson
4Department of Surgery, Michael E. DeBakey VA Medical Center, Houston, Texas
5Department of Surgery, Minneapolis VA Medical Center, Minneapolis, Minnesota
6Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
JAMA Surg. 2013;148(11):1020-1023. doi:10.1001/jamasurg.2013.3721.
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Importance  To date, no study has defined the consequences of radial artery harvest based on a large number of patients in a prospective randomized trial.

Objective  To compare pain at the harvest site and functional changes associated with harvesting the radial artery vs saphenous vein for coronary artery bypass grafting.

Design, Setting, and Participants  This study compares the consequences of radial artery harvest with saphenous vein harvest in patients undergoing elective coronary artery bypass grafting procedures in Veterans Affairs hospitals.

Main Outcomes and Measures  Eleven hospitals screened 6148 patients, of whom 751 were included in this trial. We analyzed 2 variables: pain at the harvest site as measured on a scale of 0 to 100 (least to most painful) and hand performance testing. Patients included in this analysis had radial artery only (n = 80) or saphenous vein only (n = 337) harvest. Pain score, grip strength, and dexterity were measured before surgery and at 3 and 12 months after surgery. We adjusted for pain scores of the nonharvested extremity, age, whether the patient underwent endoscopic vein harvesting, and comorbid health conditions (smoking history, type 2 diabetes mellitus, hypertension, and heart failure).

Results  There was a significant difference in change of pain score at 3 months from the preoperative baseline between radial artery and saphenous vein groups after adjusting for covariates (P < .001) but not at 12 months (P = .07). No significant changes occurred in grip strength or dexterity from preoperative baseline to 3 and 12 months after surgery (P > .05).

Conclusions and Relevance  The radial artery group reported significantly more pain than the saphenous vein group 3 months after surgery; however, similar levels of pain were observed in both groups at 12 months after surgery. Grip strength and manual dexterity were not changed by radial artery harvesting at 3 and 12 months.

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Figure 1.
Radial Artery (RA) vs Saphenous Vein (SV) Comparisons: Pain Score by Group

Pain scores are depicted for the saphenous vein and radial artery harvest groups. The pain score is based on a Likert scale. Pain was measured before surgery (time 0) and at 3 and 12 months after surgery.

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Figure 2.
Radial Artery vs Saphenous Vein Comparisons: Grip Strength in Radial Artery Harvest Arm

Hand strength (in pounds) for the hand ipsilateral to the radial artery harvest site. Measurements were made before surgery (time 0) and at 3 and 12 months after surgery.

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Figure 3.
Radial Artery vs Saphenous Vein Comparisons: 9-Hole Peg Test in Radial Artery Harvest Arm

Time (in seconds) required to complete a standardized 9-hole peg test using the arm ipsilateral to the radial artery harvest site. The 9-hole peg test was performed before surgery (time 0) and at 3 and 12 months after surgery.

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