Ten-year Echo-Doppler evaluation of forearm circulation following radial artery removal for coronary artery bypass grafting☆

Abstract

Radial artery removal for coronary artery bypass surgery leads to a chronic increase in ulnar flow accompanied by increased intima-media thickness and accelerated atherosclerotic disease. These findings may have potentially important implications for surgical indications and patients management.

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

“…Early postoperative forearm blood flow has been reported to be similar to preoperative values during exercise-induced ischemic reperfusion. 169,170 Long-term follow-up data 169,170 further suggest that the compensatory increase in ulnar artery blood flow after radial artery harvest may accelerate atherosclerosis (Fig. However, after 3 yr, blood flow increased to levels similar to those in the control arms.…”

“…167 The long-term effects of radial artery harvest were examined in a series of 34 asymptomatic patients by Serricchio et al 168 who reported that ulnar artery peak systolic velocity was greater in the operated arm compared with the control arm 5 yr after radial artery harvest. 169 A growing body of literature examining microsurgery of radial artery flap transfer supports the longterm safety of radial artery harvest. Despite this increase, handgrip exercise was associated with a decrease in transcutaneous Pao 2 and an increase in transcutaneous Paco 2 in the operated hand.…”

“…168 After 10 yr, a small degree of exercise-induced transcutaneous oxygen desaturation in the absence of symptoms was reported. 169,168 Although a rare event, the most feared complication of radial artery harvest is acute hand ischemia. 3).…”

Reply to Chong

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We thank Dr Chong [1] for his comments on our recent article [2] and congratulate its group for the nice studies on the effect of radial artery harvesting on the forearm vasculature and haemodynamics.Removal of the RA anatomically reduces to half the forearm vasculature and the fact that overall forearm flow remains constant is related to the development of ulnar artery collateral flow, as expressed by the increase in systolic velocity in this artery that ourselves and Dr Chong's group have already described.It is this increase in ulnar flow that could (at least theoretically) have contributed to the development of the ulnar artery atherosclerosis that we have found at long-term follow-up.However, Dr Chong is not correct when stating that no flow limiting lesions were reported in our study, as overt ulnar atherosclerosis was instead detected in a significant proportion of cases in the operated arm.

References[1] Chong CF. Long-term effects of radial artery harvesting on donor forearma cautionary tale.

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“…We thank Dr Chong [1] for his comments on our recent article [2] and congratulate its group for the nice studies on the effect of radial artery harvesting on the forearm vasculature and haemodynamics.…”