Endoscopic harvesting of the radial artery for neurovascular bypass

Object. The radial artery is a common conduit used for high-flow bypasses. Until now the radial artery has been harvested using a long incision in the forearm that follows the course of the artery. The authors present an endoscopic technique that has been used during coronary bypass surgery but is not yet widespread in the neurosurgical arena. Methods. From October 2006 to October 2007, the authors used the radial artery as a graft in 6 patients during the treatment of complex cerebral aneurysms. The artery was harvested via an endoscopic technique. The radial artery was exposed distally at the wrist. Using the VasoView vessel harvesting system, the endoscope was inserted into the arm. The radial artery was dissected from its surrounding tissues endoscopically. With direct current energy via the HemoPro device, the side branches were coagulated and cut. The artery was transected at the wrist, then retrieved through a counterincision at the proximal forearm. Results. There were no neurological or bleeding complications in the hand or forearm. Conclusions. Endoscopic harvesting of the radial artery is feasible, faster, and produces a more aesthetically pleasing result than standard open harvesting. The learning curve associated with the endoscope can be overcome by practice on cadavers and by collaboration with a cardiac surgical team.