Radial Artery & Saphenous Vein Harvesting

What is radial artery or saphenous vein harvesting?

Radial artery or saphenous vein harvesting is often part of coronary artery bypass surgery. It’s a procedure that takes a blood vessel from one part of your body to use as the bypass.

Your healthcare provider surgically removes either a healthy radial artery from an arm or a saphenous vein from a leg. They then attach one end of this harvested blood vessel (called a graft) to your aorta, your body’s largest artery. The other end of the graft attaches below the section of a blocked coronary artery. This harvested graft allows blood to flow freely to your heart, bypassing your blocked artery.

What is a radial artery?

Your radial artery branches from your brachial artery, a major blood vessel in your upper arm. You have a main radial artery that runs on the inside of each forearm from your elbow to your wrist. The artery lies just beneath the surface of your epidermis, the outermost layer of your skin.

What is a saphenous vein?

The saphenous vein starts in your foot and runs up your calf (lower leg). It connects to the femoral vein in your thigh. The saphenous and femoral veins in your legs have special pumping mechanisms and valves. They send blood that no longer has oxygen back to your heart to get oxygen. The saphenous vein is also known as the greater saphenous vein and long saphenous vein.

What happens before radial artery or saphenous vein harvesting?

Your healthcare provider will order tests to assess the extent of the coronary artery blockage. The results will help determine which artery or vein to harvest for the bypass surgery. These tests may include:

• Complete blood count.
• Chest X-rays.
• Imaging scans, such as a CT scan, MRI or vascular ultrasound.
• Angiogram or coronary computed tomography angiogram (CCTA).

How do healthcare providers decide which blood vessel to harvest?

Your healthcare provider will harvest either a radial artery or saphenous vein from your nondominant side. To decide which one to use, they consider your test results, as well as these factors:

• Extent and location of the blockage.
• Size of your coronary arteries.
• Which arteries and veins are healthy and available for harvesting.
• Your overall health and existing health conditions and life expectancy.

What happens before harvesting and coronary artery bypass grafting?

You should follow your healthcare provider’s instructions before the procedure. You may need to:

• Fast (not eat or drink) for a certain period of time before surgery.
• Quit smoking.
• Stop taking certain medications, including vitamins and herbal supplements.

What happens during radial artery or saphenous vein harvesting?

Blood vessel harvesting occurs immediately before the bypass procedure. You undergo heart surgery in a hospital while receiving general anesthesia.

Harvesting of a blood vessel graft may take place using:

• Endoscopic surgery: Your provider makes a couple of small incisions in your skin and inserts an endoscope. This thin, tube has a light, video camera and surgical instruments on the end. Your provider refers to images from the camera to remove the blood vessel.
• Open surgery: Your provider makes multiple longer incisions into your skin to surgically take out the blood vessel.

What happens during coronary artery bypass grafting?

You may need a heart-lung bypass machine during surgery. This machine does the job of your heart and lungs during the procedure.

During coronary artery bypass surgery, your provider:

1. Harvests the blood vessel from your chest, arm or leg.
2. Attaches one end of the harvested blood vessel (the graft) to your aorta. This is the large artery that delivers oxygenated blood from your heart to the rest of your body.
3. Attaches the other end of the harvested graft beyond the blocked artery.

What happens after artery or saphenous vein harvesting and CABG?

The following things occur after blood vessel harvesting and CABG:

• Blood flows through the new blood vessel graft to your heart, bypassing the blocked artery.
• The ulnar artery in the forearm takes over for a missing radial artery. It delivers oxygenated blood to your forearm and hand.
• Deeper veins in your leg take over for a missing saphenous vein. They return oxygen-poor blood back to your heart.

What are the benefits of artery or vein harvesting?

Blood vessel harvesting makes coronary artery bypass grafting possible. Most artery or vein harvesting procedures take place endoscopically. This minimally invasive surgery requires smaller incisions than an open surgical procedure.

Benefits of endoscopic artery or vein harvesting include:

• Faster, less painful recovery that often means a shorter hospital stay.
• Lower chance of bleeding and hematomas.
• Minimal scarring with a reduced risk of infections.

What are the risks of artery and vein harvesting?

Risks of artery or vein harvesting include:

• Bleeding and bruising.
• Blood clots.
• Damage to nearby nerves or blood vessels.
• Edema (swelling).
• Infection.
• Loss of skin sensation in the harvested area.
• Pain.
• Scarring.

What is recovery like after artery or vein harvesting?

Your main focus will be on recovering from bypass surgery. After discharge from the hospital, you should follow your healthcare provider’s instructions. This aids your recovery and lowers your risk of postoperative complications.

Your at-home recovery may include:

• Taking blood thinners (anticoagulants) or pain relievers, as directed by your provider.
• Cleaning the incision sites and changing dressings.
• Not lifting anything heavy for a set time.
• Wearing compression stockings and elevating your leg if you had saphenous vein harvesting.

What is the outlook for people who undergo artery or vein harvesting?

Coronary artery bypass surgery using a harvested blood vessel is a life-saving procedure for most people. But, 1 in 10 people who have bypass surgery using a harvested saphenous vein experience a graft failure within 12 months of the procedure. Plaque can form in the grafted vein, causing atherosclerosis that can compromise the graft blood flow in up to 50% of the vein grafts at 10 years after surgery. Blood clots and thrombosis may also occur. These complications are less likely when bypass surgery takes place using a grafted radial or internal mammary artery.

When should I call my doctor?

You should call 911 if you think you’re having a heart attack. Call your healthcare provider if you experience:

• Angina (chest pressure) or chest pain.
• Cold sweats.
• Shortness of breath (dyspnea).
• Signs of infection, such as fever or yellow discharge at the surgical sites.

A note from Cleveland Clinic

You may need radial artery or saphenous vein harvesting in addition to your internal mammary artery for use in coronary artery bypass grafting (CABG). This heart surgery treats coronary artery disease by using a harvested blood vessel to deliver blood to your heart. Your surgeon might use an internal mammary artery, radial artery or saphenous vein to bypass blocked coronary arteries. Blood vessel harvesting typically takes place using a minimally invasive endoscopic procedure. But some people need open surgery. Your healthcare provider will discuss which blood vessel to use and the best harvesting procedure for your unique situation.