Neurological Sequelae at the Harvest Site Following Endoscopic Radial Artery Harvesting
Gianluigi Bisleri1, Laura Giroletti1, Fabrizio Rosati1, Bruno Guarneri2, Claudio Muneretto1.
1University of Brescia Medical School, Brescia, Italy, 2Spedali Civili di Brescia, Brescia, Italy.
OBJECTIVE: Endoscopic harvesting of the radial artery (ERAH) has emerged as an attractive minimally invasive approach during recent years, albeit concerns have been raised about potential sensitive neurological damage occurring at the harvest limb site.
METHODS: Sixty-four patients were scheduled for CABG surgery along with endoscopic harvesting of the radial artery using a reusable retractor and a vessel sealing system. A neurological assessment at the harvest limb site was carried out post-operatively: clinical evaluation of sensory discomfort included assessment of pain (VSA score), paresthesia and dysesthesia. Electroneuromyography(ENM) was performed to evaluate sensory nerve conduction velocity (SNCV), amplitude and latency of sensory nerve action potentials (SNAPs) of the radial nerve at the harvest site (H) and compared with the contralateral limb (C).
RESULTS: ERAH was successfully performed in all cases without intraoperative complications. There was no evidence of relevant sensory alterations post-operatively at clinical examination: VSA score was 1.5±0.4 , dysesthesia and transient paresthesia occurred in 0 and 2 pts respectively with spontaneous resolution within 6 weeks. ENM depicted normal function of the radial nerve at the harvest site(H) compared to the contralateral limb(C) either in terms of sensory nerve conduction velocity (SNCVH= 52±3,8 vs SNCVC=53,2±2,8;p=NS), amplitude (SNAPH=11,9±2,7 vs SNAPC=10,8±1,8;p=NS) and latency of sensory nerve action potentials (SNAPH=1,9±0,3 vs SNAPC=2,1±0,6;p=NS).
CONCLUSIONS: ERAH is a safe procedure in terms of potential neurological damage at the harvest limb site. The functionality and nervous conduction of sensitive branch of radial nerve are not compromised as confirmed either by means of a clinical evaluation and the use of electroneuromyography.
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