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Persistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: a neglected side effect of coronary artery bypass grafting procedures Dick F; Hristic A; Roost-Krahenbuhl E; Aymard T; Weber A; Tevaearai HT; Carrel TPEur J Cardiothorac Surg 2011[Jul]; 40 (1): 221-6OBJECTIVE: The use of radial artery conduits in coronary artery bypass grafting (CABG) surgery is associated with improved long-term patency and patient survival rates as compared with saphenous vein conduits. Despite increasing popularity, relative incidence of local harvest-site complications and subjective perception of adverse long-term sequelae remain poorly described. METHODS: To allow for direct comparison, we investigated a consecutive series of patients in whom both the radial artery and the saphenous vein had been harvested for isolated CABG during a 36-month period. Patients were identified from a prospective database that collects baseline clinical information. The patients' own perceptions were assessed by a standardized direct telephone survey regarding any persistent functional impairment from their arm and leg operation sites. RESULTS: Out of 1756 CABG patients during the study period, 168 (10%) were eligible (78% men, median age: 60.1 +/- 9.6 years, range: 29.6-82.4 years). Of these, 123 (73%) could be contacted and interviewed at a median follow-up time of 2.5 +/- 0.9 years. Surgical wound complications at harvest sites (arms and legs) had occurred in 3% and 12%, respectively, and persistent symptoms (arms and legs) were self-reported as follows: chronic pain (5% and 8%), numbness (32% and 34%) and paresthesia/dysesthesia (14% and 7%). Overall, 39% of the patients reported persistent discomfort at the arm and 39% at the leg. Both sites were simultaneously affected in 21% (P = n.s., paired testing). Logistic regression modeling showed that patients with adverse long-term sequelae were younger (P < 0.005), had a higher body mass index (P < 0.05) and a lower EuroSCORE (P < 0.001) at the time of operation (EuroSCORE, European System for Cardiac Operative Risk Evaluation). Perioperative wound complications, however, did not predict persistence of symptoms. CONCLUSIONS: Persistent harvest-site discomfort occurs with astonishing frequency after CABG surgery and affects arms and legs equally. Although usually considered a minor complication, long-term limitation to quality of life may be substantial, particularly in younger and relatively healthy patients. Thus, harvest-site discomfort clearly belongs to the list of possible post-CABG complications of which patients need to be aware.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Arm/innervation[MESH]|Coronary Artery Bypass/*adverse effects/methods[MESH]|Epidemiologic Methods[MESH]|Female[MESH]|Humans[MESH]|Hypesthesia/epidemiology/etiology[MESH]|Leg/innervation[MESH]|Male[MESH]|Middle Aged[MESH]|Pain, Postoperative/epidemiology/etiology[MESH]|Paresthesia/epidemiology/etiology[MESH]|Peripheral Nerve Injuries/epidemiology/etiology[MESH]|Radial Artery/*surgery/transplantation[MESH]|Saphenous Vein/*surgery/transplantation[MESH]|Sensation Disorders/epidemiology/*etiology[MESH]|Switzerland/epidemiology[MESH]|Tissue and Organ Harvesting/*adverse effects/methods[MESH] |
