Open RA harvest technique
A standard open radial artery harvesting technique was performed as previously described (12). A skin incision was made over the course of the RA in the forearm of the nondominant hand starting from the felt pulsation of the artery till its origin from the brachial artery. The RA was harvested as a pedicle with the venae comitantes using low intensity monopolar electrocautery. No-touch technique was used, and care was taken to avoid vessel trauma during surgical manipulation. The side branches were secured with vascular clips and after haemostasis the wound was closed using 3/0 and 4/0 Vicryl and monofilament sutures. Fascia was not closed in order to prevent the occurrence of compartment syndrome.
In both techniques , the dissection was done before heparinization and RA divided after heparin was given. A soft drain was inserted in the wound and after skin closure the hand and arm were wrapped tightly with a bandage. An abdominal pad was placed under the wrap and the tourniquet deflated and removed. After completion of CABG and heparin reversal, the tight wrap was taken down and rewrapped loosely over the entire arm. The proximal anastomosis of RA was constructed in an end-to-side fashion to the aorta using 7/0 Prolene. Graft flow and pulsatility index were measured and recorded in all patients using transit time doppler flowmeter (Medistim, Medtronic, USA). Calcium channel blockers and oral nitrates were administered immediately postoperatively and continued for at least 6 months after surgery.