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Page 6 of 10 Naik et al. Vessel Plus 2018;2:38 I http://dx.doi.org/10.20517/2574-1209.2018.62

Table 1. Comparison between endoscopic vs. open radial artery harvesting [6,11,14-17,33-35,38,45,51,53,54,60,63,64]
ERAH ORAH
Pre-operative Patient selection [11,60,63,64] Comorbidities:
considerations - Diabetes
- Hypertension
Graft selection [14-17,20] Graft patency testing
- Modified Allen’s test
- Doppler ultrasound
- Direct digital pressure measurements
Previous trans-radial artery approach
Operative Duration [38] 36.5 ± 9.4 min 57.7 ± 9.4 min
factors Length of incision [33] 2-3 cm long Full length of the forearm
Cost [34,35] $550 for the endoscopic Less expensive due to
kit including the disposable fewer pieces of equipment
harmonic shears required
Expertise [36] Steep learning curve Easier to learn
Post- Hematoma (post operatively) [54] 5/100 0/100
operative [36,51-54] Wound infection (post operatively) [54] 7/100 1/100
Neuralgia restricting motor function [54] Post operatively 10/100 1/100
Neuralgia restricting motor function [54] At 1 m 8/100 1/100
Neuralgia restricting motor function [54] At 3 m 5/100 0/100
Neuralgia restricting motor function [54] At 6 m 1/100 0/100
Ecchymosis (post operatively) [54] 21/100 2/100
Wound erythema (post operatively) [54] 4/100 0/100
Mild neuralgia [54] Post operatively 31/100 18/100
Mild neuralgia [54] At 1 m 26/100 8/100
Mild neuralgia [54] At 3 m 14/100 4/100
Mild neuralgia [54] At 6 m 7/100 0/100
Patency rate (mid-term follow up period) 91%
Vasospasm (post operatively) 0.43%
ERAH: Endoscopic radial artery harvest; ORAH: open radial artery harvest

at 5 year follow-up were similar among the groups. This suggests that ERAH could provide additional short-
term benefits in terms of improved cosmesis and reduced wound and neurologic complications without
[55]
compromising the long-term clinical outcomes .

These results were confirmed by Burns et al. by demonstrating non-inferiority of ERAH with regards to
[56]
patency rates at 5 years when compared to ORAH (91.2% ERAH vs. 87.5% in ORAH, P = 0.705).

Finally, a recent meta-analysis of randomized controlled and propensity matched studies comparing the
endoscopic approach of harvesting the RA graft with the open approach demonstrated a lower incidence of
wound complications [odds ratio (OR) = 0.33, 95% CI: 0.14-0.77, P = 0.01] with similar patency rates and early
[57]
mortality rates (OR = 1.32, 95% CI: 0.76-2.27, P = 0.32 and OR = 0.78, 95% CI: 0.10-6.11, P = 0.81) [Figure 2] .
Lastly, ERAH has a steep learning curve considering the need to master manipulation of the conduit along
with the endoscope which requires an advanced hand-eye coordination. Initial experiences do indeed
describe harvest times longer than one hour [58-60] [Table 1], but other reports from the neurosurgical arena,
in which the RA is also widely used as a conduit, show that the learning curve associated with the endoscope
[61]
can be overcome by practice on cadavers .

CONCLUSION
It is suggested that standard treatment for patients with multivessel disease is use of single or bilateral ITA
[62]
along with additional arterial conduit . When appropriate, the use of RA is recommended over SV graft
since it is associated with better 5 year patency rates and improved patient longevity. The RA is preferred in
patients at risk for sternal wound complications, such as diabetics who cannot tolerate BITA grafting [18,59] .