Hemodynamic assessment of the circulation in 200 normal hands

Doscher, William

doi:10.1097/00006534-198502000-00071

Cited by 18 publications

(28 citation statements)

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“…Although the blood supply of the hand has been studied by numerous investigators, 22,28,46,47,52,55,[57][58][59][60][61][62][63][64][65] substantial variability in the anatomy of the superficial and deep palmar arches seems to be the only consistent finding (Fig. 1, Table 3).…”

Section: Anatomic Considerationsmentioning

confidence: 99%

“…125 The incorporation of plethysmography with the Modified Allen's Test allows visualization of pulsatile flow and more objective assessment of reperfusion. 133 The introduction of Doppler ultrasound in the assessment of collateral hand circulation allows for a comprehensive examination of the hand and forearm arteries 47,[63][64][65]68,69,77,100,104,134,135 (Web Supplement Table 3, see Supplemental Digital Content 3, http://links.lww.com/AA/A32). 65 However, plethysmography suffers from the inability to quantify blood flow.…”

Section: Adjuncts To the Allen's Testmentioning

confidence: 99%

“…65 However, plethysmography suffers from the inability to quantify blood flow. 63,64,68,69,77,100,101,103,104,134,136 Finally, Ruengsakulrach et al 68 suggested that no flow in the dorsal digital thumb artery with radial artery occlusion is the sole absolute contraindication for radial artery harvest. A Doppler ultrasound examination consists of 2 parts.…”

Section: Adjuncts To the Allen's Testmentioning

confidence: 99%

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Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzeziński¹,

Luisetti²,

London³

2009

Anesthesia &Amp; Analgesia

295

226

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Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

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Section: Anatomic Considerationsmentioning

confidence: 99%

Section: Adjuncts To the Allen's Testmentioning

confidence: 99%

Section: Adjuncts To the Allen's Testmentioning

confidence: 99%

See 1 more Smart Citation

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzeziński¹,

Luisetti²,

London³

2009

Anesthesia &Amp; Analgesia

295

226

View full text Add to dashboard Cite

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“…Many studies have been performed to find out which artery was dominant. Doscher et al stated that the mean diameters of the radial and ulnar arteries did not differ significantly at the wrist level [5]. Keen found that the ulnar artery was larger than the radial artery in the proximal forearm, but that the radial artery had the greater diameter at the wrist level [14].…”

Section: Discussionmentioning

confidence: 99%

Can forearm flaps be selected by use of color-flow duplex Doppler scanning?

Tuğsell

Aşsikoglu

1997

Eur J Plast Surg

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Color-flow pulsed duplex Doppler technology was used on 54 arteries in 27 healthy adult volunteers to determine dominance between radial and ulnar arteries. Volumetric flow (cc/s), flow velocity rates (cm/2), and vessel areas (mm 2) were investigated to calculate vessel dominance. Although there were some problems in five cases, 22 cases have had an absolute dominance of one artery over the other (81%). Of these, 14 cases were ulnar dominant and eight cases were radial dominant. This study proposes that the transcutaneous, noninvasive color-flow Doppler scanning makes it possible to determine the dominance of wrist arteries and helps the surgeon choose the less detrimental flap to the hand circulation before the planning of pedicled or free forearm fasciocutaneous flaps.

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“…1 Because of their importance, for over 200 years, the palmar arches have intrigued scientists, resulting in several anatomical studies of their complexity. As early as 1753, a Swiss anatomist, Albrecht von Haller, studied the anastomoses of the superficial and deep palmar arches with the ulnar and radial arteries.…”

mentioning

confidence: 99%