*Corresponding author: Gianluigi Bisleri, Cardiochirurgia SSVD – Spedali Civili, P.le Spedali Civili, 1, 25123 Brescia (Italy). Tel: +390303996401 ; Fax: +390303996096 ; Email: gianluigi.bisleri@gmail.com © 2014 mums.ac.ir All rights reserved.

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Neurological Study of Radial Nerve Conduction DuringEndoscopic Radial Artery Harvesting:An Intra‐OperativeEvaluationGianluigi Bisleri1*, Laura Giroletti1, Roberto Stefini2, Bruno Guarneri3,ClaudioMuneretto11 DivisionofCardiacSurgery,UniversityofBresciaMedicalSchool,Brescia,Italy2 DivisionofNeurosurgery,SpedaliCivili,Brescia,Italy3 SectionofNeurophysiopathology,SpedaliCivili,Brescia,Italy

ARTICLEINFO ABSTRACT

Articletype:Casereport

Endoscopic radial artery harvesting (ERAH) is a feasible and attractive minimallyinvasiveapproachforconduitprocurement,howevertherehavebeenconcernsaboutapotentialneurologicaldamageoccurringattheharvestlimbsitesecondarytoinjuryoftheradialnerveduringendoscopicharvesting.WepresentacaseofERAHinwhichweevaluatedintraoperativelythecharacteristicsofradialnerveconductionbymeansof electroneuromyography (ENM) during harvesting. No pathological changes ofnerve conduction were detected at the harvest limb site during surgery andpostoperatively,therebysupportingthebenefitsoftheendoscopicapproachintermsof neurological outcomes following radial artery procurementswith a less invasiveapproach.

Articlehistory:Received:21March2014Revised:10April2014Accepted:15Jul2014

Keywords:EndoscopicHarvestingNerveConductionRadialArteryRadialNerve

►Please cite this paper as: Bisleri G, Giroletti L, Stefini R, Guarneri B, Muneretto C. Neurological Study of Radial Nerve Conduction DuringEndoscopicRadialArteryHarvesting:AnIntra‐OperativeEvaluation.JCardiothoracMed.2014;2(3):207‐209.

IntroductionEndoscopic radial artery harvesting (ERAH)

has emerged in recent years as an attractivealternative approach to conventional openharvesting technique and several reportspreviously demonstrated the feasibility andsafety of this novel approach for radial arteryprocurement (1,2). Despite the obviousadvantages related to the use of a minimallyinvasiveapproach,suchasareducedincidenceofwound complications and improved cosmetics,there have been controversial results about thepersistence of potential impairment at theharvestlimbsiteduringendoscopicradialarteryharvesting, mostly in relation with a damageoccurringattheradialnerve(3).

Wethereforesoughttoevaluatethepotentialalterations occurring in terms of radial nerveconduction intraoperatively during ERAH bymeansofelectroneuromiography(ENM).

CasePresentationA 51‐year‐old woman was diagnosed with

intracranial meningioma and admitted toDivisionofCardiacSurgery,UniversityofBresciaMedicalSchool,Brescia,Italyinordertoundergoan extra‐intracranial high‐flow bypass with theuseofaradialarteryastheconduitofchoice.Thepatient signed an informed consent for theprocedure.

Following confirmation of a negative Allentest at thenon‐dominantarm, endoscopic radialartery harvestingwas performed bymeans of anon‐sealedsystemcombiningareusablestainlesssteel retractor (Karl Storz,Tuttlingen,Germany)andadisposablevesselsealingsystem(Ligasure,Covidien, Boulder, CO): as previously described(4), a 2 cm longitudinal incisionwas performedonthevolarsurfaceoftheforearm,atthelevelofthe radial styloid prominence. Once the radialarteryhas been separated as a pedicled conduit

 

Bisleri G et a

208

 

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iscussionNeurologicalnalradialartportedtooccuat is, from 0rvous injurynbemultifacttheforearm,action. A releproach is reurytothelathich insteadchnique. Howported in litecidence of nedoscopicradifferent techocurement mmplications,chnologiesalldlimitednervvantages. Inellasinthecuusable retracstem with bip

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Neurological Study During Endoscopic Radial Artery Harvesting   Bisleri G et al  

J Cardiothorac Med. 2014; 2(3):207-209. 209

impedance algorithmwhich allows for a tailoredenergy delivery and adjustment with minimalthermal spread. The possibility to monitorintraoperatively the radial nerve conduction viaENM provided us with a unique opportunity todemonstrate that endoscopic radial arteryharvesting with our current approach does notalternerveconduction.

ConclusionFurther studies on a larger series of patients

alongwithacomprehensivepostoperativeclinicalevaluationarewarranted inorder to confirm thereal impact of neurological sequelae followingendoscopicprocurementoftheradialartery,albeitthisstudydemonstratedforthefirsttimethatthisminimally invasive technique does not directlycauseradialnerveconductionabnormalities.

ConflictofInterestTheauthorsdeclarenoconflictofinterest.

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McCabe JC, Loulmet DF, et al. Endoscopic RadialArtery Harvesting: Results of First 300 Patients.AnnThoracSurg,2002;74:502–6.

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