Radial artery & saphenous vein harvesting

Overview 

In coronary artery bypass surgery, surgeons often harvest a healthy blood vessel, such as the radial artery from the arm or the saphenous vein from the leg, to use as a graft. This graft is used to bypass a blocked coronary artery, restoring proper blood flow to the heart. One end of the graft is attached to the aorta, the body’s largest artery, while the other end is connected below the blockage, allowing blood to flow freely around the obstruction. 

The radial artery, located in the forearm, branches off from the brachial artery, a major blood vessel in the upper arm. Running from the elbow to the wrist, this artery lies just beneath the outer layer of skin. Its accessibility and proximity to the surface make it a common choice for harvesting during bypass surgery.

The saphenous vein, also called the greater or long saphenous vein, runs from the foot up through the calf and connects with the femoral vein in the thigh. This vein plays an essential role in returning deoxygenated blood to the heart. Its large size and length make it suitable for grafting in coronary bypass procedures. 

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, magnetic resonance imaging (MRI), and computed tomography (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.