Safe removal of the radial artery for myocardial revascularization: A doppler study to prevent ischemic complications to the hand

Abstract

Radial artery harvesting has recently been reintroduced for myocardial revascularization. Harvesting the radial artery may jeopardize the vascularization of the hand; cautious selection of candidates must therefore be pursued. The study involved 188 consecutive patients. We verified the patency of the upper limb's arteries and the adequacy of the ulnar supply by static and dynamic Doppler evaluations. The use of the radial artery was contraindicated in 14 cases (three for stenosis of the subclavian artery and 11 for inadequate collateralization). One hundred patients were operated on with the radial artery used as a graft; the remaining 74 patients had a different conduit placed. The vascularization of the hand was restudied within 10 days in all patients who underwent operation; in 63 patients, it was studied again at 1 year. The early Doppler examination showed significant increase in blood flow velocities in the ulnar artery, with a flow redistribution in the common digital palmar arteries (decreased in the first and increased in the second and the third). The late Doppler examination showed superimposable findings. No local ischemic complications were observed. We conclude that Doppler study is a useful tool in preoperative screening of candidates for radial artery harvesting for myocardial revascularization.

Arco palmar superficial: anatomía e implicaciones clínicas

“…Para determinar la configuración del APS en un paciente, es necesario implementar un test de Allen y un estudio imagenológico como el test doppler color, siendo este la prueba más confiable y segura al evaluar la AR como posible IBC 7,8 . El uso de la AR como injerto en la revascularización miocárdica, ha generado un interés por el estudio del APS.…”

“…Por tanto, el test de Doppler es el estudio más confiable para evaluar la irrigación de la mano. El éxito de la extracción de la AR se aprecia en la ausencia de complicaciones circulatorias en la mano y en el incremento persistente en las velocidades de flujo sanguíneo de la AU un año después de la intervención, en el que el flujo por el APS y las arterias digitales palmares comunes debe ser similar al observado en la exanimación prequirúrgica 8 .…”

Long-Term Results of the Radial Artery Used for Myocardial Revascularization

“…[1][2][3][4][5][6] In this report, we describes the long-term angiographic results of the first 90 consecutive, surviving patients in whom the RA was used as a coronary artery bypass conduit directly anastomosed to the ascending aorta. Cases in whom the RA was used as a composite conduit proximally anastomosed to a mammary graft were not included in this analysis.…”

“…2 The RA was always harvested from the nondominant arm; bilateral RA harvesting was never performed. In 1 case, the RA was divided in 2 separate grafts, so that the overall number of RA grafts was 91 in the 90 patients.…”

Assesment of Radial Artery by Means of Doppler Ultrasonography and Soft Tissue Roentgenogram in End-Stage Renal Disease Patients

“…assessing the hand circulation, and the benefits are also recorded [5,6]. But, diffuse calcified radial artery in case with coronary artery disease have been reported by Dogan et al using computed tomography of the forearm before the radial artery harvesting in CABG patients for the first time [7].…”