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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, Florian ; Hristic, Ana ; Roost-Krähenbühl, Eva ; Aymard, Thierry ; Weber, Alberto ; Tevaearai, Hendrik T. ; Carrel, Thierry P.

In: European Journal of Cardio-Thoracic Surgery, 2011, vol. 40, no. 1, p. 221-226

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    Titre
    • Persistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: a neglected side effect of coronary artery bypass grafting procedures
    Auteur
    • Dick, Florian. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    • Hristic, Ana. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    • Roost-Krähenbühl, Eva. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    • Aymard, Thierry. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    • Weber, Alberto. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    • Tevaearai, Hendrik T.. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    • Carrel, Thierry P.. Clinic for Cardiovascular Surgery, Inselspital Berne, Berne University Hospital and University of Berne, Berne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2011, vol. 40, no. 1, p. 221-226. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:301511
    Summary
    Objective: 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