Radial artery & saphenous vein harvesting

Overview

Radial artery or saphenous vein harvesting is a surgical procedure that involves removal of a healthy artery from the arm or a vein from the leg to use as a graft. This procedure is commonly used in coronary artery bypass grafting (CABG), a surgery to treat coronary artery disease.

In a radial artery or saphenous vein harvesting, a healthy blood vessel is taken from either the arm (radial artery) or leg (saphenous vein) and used to create a bypass around a blocked coronary artery. One end of the harvested vessel is attached to the aorta, the body’s main artery, and the other end is connected below the blocked artery, allowing blood to bypass the blockage and flow freely to the heart.

Reasons for undergoing the procedure

Radial artery or saphenous vein harvesting is commonly performed as part of coronary artery bypass grafting (CABG) surgery. The healthcare provider may use an internal mammary artery, a radial artery from the wrist, or a saphenous vein from the leg to bypass blocked coronary arteries. 

The decision on which vessel to use depends on test results and factors like the location and severity of the blockage, the size of the coronary arteries, the condition of available arteries and veins, and the patient’s overall health and life expectancy. Harvesting is typically done from the nondominant side of the patient.

Risk

All medical procedures carry certain risks. Common complications with radial artery or saphenous vein harvesting include:

• Risk of infection
• Development of scars
• Pain
• Swelling, or edema
• Bleeding and bruising
• Formation of blood clots
• Injury to surrounding nerves or blood vessels
• Reduced skin sensation in the donor area

Before the procedure

Pre-procedure instructions will be provided by the healthcare provider, which may include fasting, quitting smoking, and stopping certain medications, vitamins, or supplements.

To assess the extent of coronary artery blockage and decide which artery or vein to use for bypass surgery, tests will be ordered. This may include:

• Imaging tests, including vascular ultrasonography, MRIs, and CT scans
• Coronary computed tomography angiography, also known as an angiogram (CCTA)
• Chest X-rays 
• Complete blood count

During the procedure

There are two main methods in vein harvesting:

• Open surgery: To remove the blood vessels surgically, several longer skin incisions are made.
• Endoscopic surgery: This minimally invasive method uses smaller incisions compared to open surgery, making the procedure less invasive. An endoscope, a thin tube with a camera and tools, is inserted through the incisions. To cut the blood vessels, camera images generated by the device is used. 

Blood vessel harvesting is typically performed just before the bypass procedure while the patient is under general anesthesia in a hospital.

After the procedure

After blood vessel harvesting and coronary artery bypass grafting (CABG), blood flows through the new grafts, bypassing the blocked coronary arteries. If the radial artery is removed, the ulnar artery in the forearm compensates by supplying oxygenated blood to the forearm and hand. In the leg, deeper veins assume the role of the removed saphenous vein, aiding in the return of oxygen-depleted blood to the heart.

Outcome

After discharge from the hospital, it is crucial to follow your healthcare provider’s instructions to support healing and monitor for potential complications. Seek immediate medical attention if you experience:

• Symptoms of infection, such as fever or yellow discharge from surgical sites
• Chest pressure or pain (angina)
• Cold sweating
• Difficulty breathing (shortness of breath or dyspnea)

Endoscopic artery or vein harvesting generally offers benefits like faster recovery, reduced pain, shorter hospital stays, minimal scarring, and a lower risk of bleeding and infection.

While coronary artery bypass surgery using a harvested blood vessel can be life-saving, complications may arise, including graft failure, atherosclerosis, blood clots, and thrombosis. Saphenous vein grafts, in particular, have a 10% failure rate within the first year, and up to 50% may experience compromised blood flow after 10 years. These issues are less frequent with grafts using the radial or internal mammary artery.