Genovesi M H, Torrillo L, Fonger J, Patel N, McCabe J C, Subramanian V A
Lenox Hill Hospital, New York, NY, USA.
Heart Surg Forum. 2001;4(3):223-4; discussion 224-5.
Although early attempts to use the radial artery (RA) as a conduit for cardiac revascularization met with disappointing results, recent data have shown the RA to achieve very good short-term patency as well as promising mid-term patency results. The recent increase in the frequency of coronary reoperations, with their limited options for vascular conduits, has also stimulated an interest in the RA graft. The success of minimally invasive vein harvesting techniques encouraged us to develop a minimally invasive technique for harvesting the RA from the forearm, which is reviewed in this article.
The endoscopic harvest technique was employed on more than 120 nonselected patients at our facility over a 12-month period. The procedure involved exposure of the RA under direct visualization and without direct manipulation, using an endoscopic dissector and harmonic shears. Side branches of the RA were isolated and divided, and the vessel was removed and side branch occlusion verified. The harvested RA was then prepared for the revascularization surgery.
The patients who underwent the procedure showed no evidence of graft spasm or occlusion in the immediate postoperative period. Patients also preferred the small endoscopic incision to the full forearm incision of the "open" technique.
Our experience indicates that endoscopic radial artery harvesting is a safe technique that achieves good short-term patency results and improved patient satisfaction. Evaluation of long-term vessel integrity is needed, and a comparison of the minimally invasive and the open technique has been initiated.
尽管早期将桡动脉（RA）用作心脏血运重建管道的尝试结果令人失望，但近期数据显示桡动脉具有非常良好的短期通畅率以及有前景的中期通畅率结果。近期冠状动脉再次手术频率增加，且血管管道选择有限，这也激发了对桡动脉移植物的兴趣。微创静脉采集技术的成功促使我们开发一种从前臂采集桡动脉的微创技术，本文对此进行综述。
在12个月期间，我们机构对120多名未经过筛选的患者采用了内镜采集技术。该手术包括在直视下暴露桡动脉，不进行直接操作，使用内镜分离器和谐波剪。分离并切断桡动脉的侧支，取出血管并确认侧支闭塞。然后将采集到的桡动脉准备用于血运重建手术。
接受该手术的患者在术后即刻没有出现移植物痉挛或闭塞的迹象。患者也更喜欢内镜小切口，而不是“开放”技术的全前臂切口。
我们的经验表明，内镜下桡动脉采集是一种安全的技术，可实现良好的短期通畅率结果并提高患者满意度。需要评估长期血管完整性，并且已经开始对微创技术和开放技术进行比较。
