Technique for harvesting the radial artery as a coronary artery bypass graft

The radial artery was proposed and then abandoned as a coronary artery bypass graft in the 1970s. Development of new pharmacologic antispasmodic agents and minimally traumatic harvesting techniques has led to a revival of the use of the radial artery in coronary artery bypass procedures. Unlike the saphenous vein in the lower extremities, the radial artery in the volar forearm is not a subcutaneous structure. Safe harvest of the artery requires an understanding of volar forearm anatomy. Based on review of anatomy, cadaver dissection, and clinical experience with 40 patients, we have developed a technique for radial artery harvest. The volar forearm is divided into three zones: the proximal zone, the middle zone, and the distal zone. In each zone, important anatomic landmarks are identified. Our harvesting technique has resulted in minimal postoperative morbidity and no postoperative ischemic complications. Although the pedicled internal thoracic artery graft remains the primary arterial conduit for myocardial revascularization, the radial artery is an excellent additional bypass conduit.