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Pneumatic Tourniquet In Endoscopic Radial Artery Harvesting. The Oxford Experience On How And When To Do It
Jasmina Ttofi, Michael Turton, Estelle Eaglestone, Jyothi Nair, Andrea DAlessio, Iakovos Ttofi, George Krasopoulos, Vivek Srivastava;
Oxford University Hospitals, Oxford, United Kingdom
BACKGROUND: Endoscopic radial harvesting (ERAH) is the second most common endoscopic harvesting technique at the Oxford Heart Centre. We are reporting the Oxford experience with the use of pneumatic tourniquet for ERAH along with technical and other considerations.
METHODS: Prospectively collected data of ERAH were retrospectively analysed. The ERAH cases were divided into two groups and the results were directly compared. The technique of the tourniquet application along with tips and pitfalls were reviewed.
RESULTS: ERAH was performed in 528 patients of which 307 were harvested using pneumatic tourniquet, 2 cases (<1%) had to be converted to open technique and 17 patients had open radial harvesting. Average harvesting time for ERAH is 25min and over 40 min under pulsatile flow. 4.2 ERAH procedure is done without application of systematic Heparin of 2.500 IU unless performed simultaneously with the endoscopic vein harvesting. 2 cases (< 1 %) were converted to open due to the bleeding at the early phase of training, without tourniquet application. Average harvesting time for ERAH in early experience was 50min for first 20 cases to improve to 25 min for experienced SCP. 15 patients had ERAH with application of pneumatic tourniquet, with Heparin administration, absence of bleeding and harvesting time of 15min. No post-operative compilations were recorded in both groups for past two years. The full indications, technique, and pitfalls in using the tourniquet for ERAH will be presented.
CONCLUSIONS: This research affirms that endoscopic conduit harvesting, especially EVH and ERAH, stands as a safe and efficient method for CABG procedures. Patients undergoing these techniques experienced rapid postoperative recovery, minimal complications, and heightened satisfaction. Furthermore, these approaches decreased postoperative pain and reduced the need for wound-management resources. The study underscores the importance of standardized training for surgical care practitioners to maintain these positive outcomes and sustain consistently low SSI rates.
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