Chronic Neuropathy of the Lateral Antebrachial Cutaneous Nerve after Endoscopic Radial Artery Harvest: A Case Report.

Abstract

Introduction: Neurologic complications after radial artery harvest for coronary artery bypass grafting (CABG) remain incompletely characterized, particularly after endoscopic radial artery harvest (ERAH). As the radial artery has become the preferred second arterial conduit due to its superior long-term outcomes, ERAH has gained popularity as a minimally invasive alternative to open harvest with favorable cosmetic and wound outcomes. Although prior studies suggest neurologic symptoms are often transient, persistent sensory deficits may be underrecognized. The lateral antebrachial cutaneous nerve (LABC) is anatomically vulnerable during harvest, yet its injury has been reported mainly in open techniques. Because the sensory territories of the LABC and the superficial branch of the radial nerve overlap, LABC injury after ERAH may be overlooked. We present a detailed case of LABC injury following ERAH to further characterize this complication and inform pre-operative counseling.

Case report: A 68-year-old female presented to our clinic with chronic left radial and dorsal forearm pain with onset a few days following a CABG. The pain radiates from the dorsal aspect of her thumb and index finger to just distal to her elbow on the lateral aspect of her forearm, and conservative management provided minimal relief. She had temporary symptom relief following hydrodissection and nerve block injection, noting recurrence shortly after the procedure. She was treated with surgical exploration, removal of foreign bodies, and nerve reconstruction with an allograft. Postoperatively, she experienced improvement in her pre- operative radiating forearm pain, but still had persistent numbness - which is expected in the early post-operative interval.

Conclusion: We present a case of a 68-year-old patient who had LABC nerve injury after ERAH, demonstrating that clinically significant focal sensory neuropathy can occur despite the minimally invasive nature of this technique. This case highlights the anatomic vulnerability of the LABC within the harvest corridor and suggests that some post-operative radial-sided sensory symptoms may be underrecognized or misattributed due to overlapping cutaneous territories and limited nerve-specific assessment in prior studies.