Study of Endoscopic Versus Open Harvest of the Radial Artery in Coronary Artery Bypass Surgery
Condition: Coronary Artery Disease
MeSH terms: Coronary Artery Disease
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      The purpose of this study is to compare the safety and effectiveness of minimally invasive
      endoscopic harvest of the radial artery to the conventional open method of radial artery
      harvest in coronary artery bypass surgery. The researchers hypothesize that the radial artery
      can be safely, efficiently, and routinely harvested using a minimally invasive endoscopic
      technique. Endoscopic minimally invasive harvesting of the radial artery will reduce the
      postoperative morbidity due to pain, wound infection, and neurological complications and
      improve cosmetic results.
    

Detailed description: 
      Many surgical disciplines have been quick to adopt minimally invasive techniques because of
      decreased complications and shorter recovery times. As we enter the fifth decade of coronary
      artery bypass grafting surgery more attempts are being made to perform the operation less
      invasively. Harvesting of the saphenous vein (a large superficial vein in the leg which is
      routinely used in bypass surgery) using a telescope (camera), has been shown to be superior
      to harvesting the vein through a large open incision. At our institution, this vein mentioned
      above, is routinely harvested using less invasive techniques with a camera. This has been
      shown to result in less infection.

      In the early 1990's, the radial artery was reintroduced into bypass surgery to increase the
      number of available alternative bypass grafts. Long-term results of the radial artery (8-9
      years) have shown that 88-91% of the radial arteries harvested remain open thereby allowing
      the flow of blood. This is significantly better than the 10-year rates of the saphenous vein
      of 53-67%. Therefore, the radial artery has become more popular as a bypass graft.

      Conventionally, the radial artery is harvested by making a long vertical incision extending
      from the wrist to the elbow. The radial artery is then dissected under direct vision within
      this large open incision. Complications from the open harvest of the radial artery include
      infection, neurological complications, possible decrease blood flow to the hand, and poor
      wound healing or scarring.

      Recently, with the development of endoscopic harvesting systems, the radial artery can be
      harvested using a telescope (camera) and very small incisions. Thus far, to our knowledge
      there have been no published studies comparing conventional techniques to less invasive
      endoscopic techniques for harvesting the radial artery. Therefore, we propose a prospective
      randomized study to determine if the radial artery can be routinely harvested using an
      endoscopic minimally invasive technique. We wish to compare the conventional open technique
      to the minimally invasive technique to determine if there are any differences in
      postoperative complications, length of hospital stay or possible differences in patient
      satisfaction in cosmetic results (scarring) between the two techniques.
    

Intervention name(s): Endoscopic Radial Artery Harvest
Intervention type(s): Procedure
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: CABG, Endoscopic, Radial Artery; Radial Artery Conduit; Coronary Artery Bypass Surgery; Endoscopic technique