Radial Artery Harvest

The radial artery runs down the thumb side of the forearm to the wrist, where it joins the ulnar artery through the arches of the palm. Because the hand can be fed by the ulnar artery alone in most people, the radial artery can be taken out and used as a bypass graft. After the left internal mammary artery, it is the arterial conduit most often recommended for the second most important blocked coronary artery, because it stays open longer than a saphenous vein graft. It is usually taken from the nondominant (most often left) arm, at the same time as the sternotomy and mammary harvest. Before surgery the ulnar side must be shown to carry enough blood to the hand, with an Allen test (often using pulse oximetry or Doppler) and sometimes an ultrasound. No IV lines or needle sticks go in that arm. The radial artery has a thick muscular wall and goes into spasm easily, so it is handled as little as possible ('no touch'), taken with its two companion veins and the fat around it, kept moist with papaverine, and stored in a solution of heparin and papaverine (often in the patient's own heparinized blood). Many patients also get IV nitrates or calcium channel blockers during and after surgery. The artery can be taken through one long forearm incision (open harvest) or endoscopically through a small wrist incision with a vessel-harvesting system, which gives a better-looking scar and fewer wound infections with similar graft results. The nerves at risk are the lateral cutaneous nerve of the forearm and the superficial radial nerve, which can leave numbness of the thumb side of the hand; bleeding into the arm, and very rarely compartment syndrome or poor blood flow to the hand, are the other complications to watch for.