***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND For coronary surgery we often use the radial artery ( RA ) instead of the saphenous vein , trying to exploit the advantages offered by this conduit . To eliminate the problems regarding alteration of upper-extremity function after RA procurement related to the st and ard conventional harvesting technique , we started using the less invasive harvesting technique with surprisingly good preliminary results . To compare the outcomes of open versus less invasive harvesting procedures , a prospect i ve , nonr and omized study was developed by 2 centers . METHODS From January 2001 to March 2003 , there were 87 consecutive patients in the less invasive radial artery harvesting ( LIRAH ) group and 90 patients in the conventional radial artery harvesting ( CRAH ) group . Patient characteristics and demographics were similar in the groups . Data collection was made to evaluate possible benefits of the LIRAH technique in terms of fewer forearm and h and complications , better aesthetics , and improved patient satisfaction . RESULTS Between January 11 , 2001 , and March 30 , 2003 , 177 patients underwent either primary or redo coronary artery revascularizations  with procurement of the RA for use as a conduit with the less invasive harvesting technique . The mean follow-up was 2 months . Four patients died , and overall mortality was 2.26 % . One hundred seventy-three patients were successfully examined during the first postoperative control , 85 in the LIRAH group and 88 patients in the CRAH group . Objective and subjective data were collected from the consultant . The overall average age was 60.5 years ( range , 40 - 77 years ) . In the LIRAH group , the mean overall incision length ( when 2 incisions were necessary , both incision lengths were measured ) was 5.6 cm ( range , 4 - 10 cm ) , and the mean vessel length was 16 cm ( range , 10 - 19 cm ) . Eighteen patients ( 20.6 % ) necessitated double incision . Mean harvesting time ( from incision to skin closure ) was 43.3 min ( range , 25 - 70 min ) . Fourteen patients ( 16.4 % ) presented some kind of complication during the study . There were no cases with acute ischemia , bleeding , or re-exploration . Seventy-five patients ( 88.2 % ) found the cosmetic result excellent . Ten patients ( 11.8 % ) found it good , and none considered it mediocre . In the CRAH group , the mean incision length was 20 cm ( range , 18 - 22 cm ) , and the mean vessel length was 18 cm ( range , 17 - 20 cm ) . Mean harvesting time ( from incision to skin closure ) was 30.8 min ( range , 14 - 45 min ) . Thirty-four patients ( 38.6 % ) presented some kind of complication during the study . Three patients ( 3.5 % ) found the cosmetic result excellent . Forty-three ( 48.8 % ) found it good , and 42 ( 47.7 % ) considered it mediocre . CONCLUSIONS A potential of fewer neurological forearm postoperative complications , better aesthetics , and improved patient satisfaction can be achieved by the LIRAH technique OBJECTIVE To compare the endothelial integrity of radial artery grafts harvested by minimally invasive surgery and arteries harvested conventionally for coronary artery bypass surgery ( CABG )  in 200 participants , who were assigned to interventions by using r and om allocation . METHODS An immunohistochemical procedure with monoclonal antibodies was employed to estimate CD31 antigen and endothelial nitric oxide synthase ( eNOS ) expressions - markers defining endothelial integrity . RESULTS The CD31 immunostaining revealed that the endothelial cell integrity of the minimally invasive harvested arteries was preserved in 76.1±7.4 % of the circumference of luminal endothelium , which was similar to results obtained in conventionally harvested grafts ( 77.2±9.8 % ; not significant ) . On the other h and , eNOS immunostaining indicated that the endothelial integrity of the minimally invasive harvested grafts was preserved in 75.4±10.5 % while in conventionally harvested grafts it was reduced to 42.4±14.5 % of the total luminal endothelium circumference ( P<0.05 ) . CONCLUSIONS The endothelial integrity of radial artery grafts harvested by minimally invasive surgery is better preserved than in the grafts obtained by the conventional manner . This could play an important role in improving graft patency and might represent a preliminary condition of stable functioning in coronary arterial bypasses OBJECTIVES The purpose of this study was to present radial and saphenous vein graft ( SVG ) occlusion results more than 5 years following  coronary artery bypass surgery .  BACKGROUND In the RAPS ( Radial Artery Patency Study ) study , complete graft occlusion was less frequent in radial artery compared with SVG 1 year post-operatively while functional occlusion ( Thrombolysis In Myocardial Infa rct ion flow grade 0 , 1 , 2 ) was similar . METHODS A total of 510 patients < 80 years of age undergoing primary isolated nonemergent coronary artery bypass grafting with 3-vessel disease were initially enrolled in 9 Canadian centers . Target vessels for the radial artery and study SVG were the right and circumflex coronary arteries , which had > 70 % proximal stenosis . Within-patient r and omization was performed ; the radial artery was r and omized to either the right or circumflex territory and the study SVG was used for the other territory . The primary endpoint was functional graft occlusion by invasive angiography  at least 5 years following surgery . Complete graft occlusion by invasive angiography or computed tomography angiography  was a secondary endpoint . RESULTS A total of 269 patients underwent late angiography  ( 234 invasive angiography , 35 computed tomography angiography ) at a mean of 7.7 ± 1.5 years after surgery . The frequency of functional graft occlusion was lower in radial arteries compared with SVGs ( 28 of 234 [ 12.0 % ] vs. 46 of 234 [ 19.7 % ] ; p = 0.03 by McNemar 's test ) . The frequency of complete graft occlusion was also significantly lower in radial compared with SVGs ( 24 of 269 [ 8.9 % ] vs. 50 of 269 [ 18.6 % ] ; p = 0.002 ) . CONCLUSIONS Radial arteries are associated with reduced rates of functional and complete graft occlusion compared with SVGs more than 5 years following surgery . ( Multicentre Radial Artery Patency Study : 5 Year Results ; NCT00187356 ) BACKGROUND Endoscopic radial artery harvest provides better cosmetic result without compromising the quality of the graft . We sought to compare postoperative harvesting site neurologic and vascular outcome . METHODS From 10/2002 until 10/2004 , 50 patients were r and omized to have their radial artery harvested for coronary bypass either endoscopically ( group A , n = 25 ) or conventionally ( group B , n = 25 ) . Radial arteries were preoperatively evaluated by Doppler echocardiography .  Neurologic and functional status was assessed by a self reporting question naire with a semiquantitative ( 1 - 5 ) scale . Vascular status of the forearm was assessed by control echocardiography . RESULTS At an average follow-up of 37 + /- 7 months , patients undergoing endoscopic radial artery harvesting had less overall neurologic complications ( 11 versus 17 patients , P = .023 ) and they were less severe ( 0.8 + /- 1.1 versus 2.2 + /- 1.2 ; P < .001 ) . Ulnar flow increase was similar among the groups : 13.1 + /- 5.43 cm/s in group A versus 15.9 + /- 4.9 cm/s in group B ( P = .147 ) as well as ulnar artery diameter increase 0.29 + /- 0.16 mm in group A versus 0.29 + /- 0.26 cm in group B ( P = .914 ) . CONCLUSION Endoscopic radial artery is safe and does not compromise graft quality or forearm and h and circulation postoperatively . Along with providing a better cosmetic result , endoscopic artery harvesting reduces postoperative harvesting site pain and neurologic complications BACKGROUND We report the 5-year results of the SYNTAX trial , which compared coronary artery bypass graft surgery ( CABG ) with percutaneous coronary intervention ( PCI ) for the treatment of patients with left main coronary disease or three-vessel disease , to confirm findings at 1 and 3 years . METHODS The r and omised , clinical SYNTAX trial with nested registries took place in 85 centres in the USA and Europe . A cardiac surgeon and interventional cardiologist at each centre assessed consecutive patients with de-novo three-vessel disease or left main coronary disease to determine suitability for study treatments . Eligible patients suitable for either treatment were r and omly assigned ( 1:1 ) by an interactive voice response system to either PCI with a first-generation paclitaxel-eluting stent or to CABG . Patients suitable for only one treatment option were entered into either the PCI-only or CABG-only registries . We analysed a composite rate of major adverse cardiac and cerebrovascular events ( MACCE ) at 5-year follow-up by Kaplan-Meier analysis on an intention-to-treat basis . This study is registered with Clinical Trials.gov , number NCT00114972 . FINDINGS 1800 patients were r and omly assigned to CABG ( n=897 ) or PCI ( n=903 ) . More patients who were assigned to CABG  withdrew consent than did those assigned to PCI ( 50 vs 11 ) . After 5 years ' follow-up , Kaplan-Meier estimates of MACCE were 26·9 % in the CABG group and 37·3 % in the PCI group ( p<0·0001 ) . Estimates of myocardial infa rct ion ( 3·8 % in the CABG group vs 9·7 % in the PCI group ; p<0·0001 ) and repeat revascularisation ( 13·7%vs 25·9 % ; p<0·0001 ) were significantly increased with PCI versus CABG . All-cause death ( 11·4 % in the CABG group vs 13·9 % in the PCI group ; p=0·10 ) and stroke ( 3·7%vs 2·4 % ; p=0·09 ) were not significantly different between groups . 28·6 % of patients in the CABG group with low SYNTAX scores had MACCE versus 32·1 % of patients in the PCI group ( p=0·43 ) and 31·0 % in the CABG group with left main coronary disease had MACCE versus 36·9 % in the PCI group ( p=0·12 ) ; however , in patients with intermediate or high SYNTAX scores , MACCE was significantly increased with PCI ( intermediate score , 25·8 % of the CABG group vs 36·0 % of the PCI group ; p=0·008 ; high score , 26·8%vs 44·0 % ; p<0·0001 ) . INTERPRETATION CABG should remain the st and ard of care for patients with complex lesions ( high or intermediate SYNTAX scores ) . For patients with less complex disease ( low SYNTAX scores ) or left main coronary disease ( low or intermediate SYNTAX scores ) , PCI is an acceptable alternative . All patients with complex multivessel coronary artery disease should be review ed and discussed by both a cardiac surgeon and interventional cardiologist to reach consensus on optimum treatment . FUNDING Boston Scientific We present a less traumatic surgical technique for harvesting the radial artery as a coronary artery bypass graft that does not require any special equipment or skills . We prospect ively r and omized 40 patients undergoing coronary artery bypass grafting with the radial artery into two groups on the basis of harvest techniques : tunneling excision and conventional open method . The less-invasive tunneling technique is safe , easily applicable , and preferred by patients because of the superior cosmetic result BACKGROUND In the past decade , the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm . Graft patency is a key predictor of long-term survival . We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a r and omized trial in which we controlled for bias in the selection of patients and vessels . METHODS We enrolled 561 patients at 13 centers . The left internal thoracic artery was used to bypass the anterior circulation . The radial-artery graft was r and omly assigned to bypass the major vessel in either the inferior ( right coronary ) territory or the lateral ( circumflex ) territory , with the saphenous-vein graft used for the opposing territory ( control ) . The primary end point was graft occlusion , determined by angiography 8 to 12 months postoperatively . RESULTS Angiography was performed at one year in 440 patients : 
    Output:
    
There were no statistically significant differences in overall mortality , recurrent myocardial infa rct ion , or graft patency between the two surgical techniques .
However , patients who underwent endoscopic harvesting were found to have significantly lower incidences of wound infection , hematoma formation , and paresthesia .
However , the available evidence suggests that the endoscopic approach is associated with superior perioperative outcomes without clear evidence demonstrating compromised patency or survival outcomes