Open RA harvest technique
A standard open radial artery harvesting technique was performed as
previously described (12). A skin incision was made over the course of
the RA in the forearm of the nondominant hand starting from the felt
pulsation of the artery till its origin from the brachial artery. The RA
was harvested as a pedicle with the venae comitantes using low intensity
monopolar electrocautery. No-touch technique was used, and care was
taken to avoid vessel trauma during surgical manipulation. The side
branches were secured with vascular clips and after haemostasis the
wound was closed using 3/0 and 4/0 Vicryl and monofilament sutures.
Fascia was not closed in order to prevent the occurrence of compartment
syndrome.
In both techniques , the dissection was done before heparinization
and RA divided after heparin was given. A soft drain was inserted in the
wound and after skin closure the hand and arm were wrapped tightly with
a bandage. An abdominal pad was placed under the wrap and the tourniquet
deflated and removed. After completion of CABG and heparin reversal, the
tight wrap was taken down and rewrapped loosely over the entire arm. The
proximal anastomosis of RA was constructed in an end-to-side fashion to
the aorta using 7/0 Prolene. Graft flow and pulsatility index were
measured and recorded in all patients using transit time doppler
flowmeter (Medistim, Medtronic, USA). Calcium channel blockers and oral
nitrates were administered immediately postoperatively and continued for
at least 6 months after surgery.