Radial artery harvesting for coronary artery bypass grafting: a stepwise-made decision.

Full Abstract

BACKGROUND:
The purpose of this study was to propose a safe, stepwise, testing system to select radial arteries that are suitable for conduits on the basis of their morphologies and characteristics of the collateral circulation.

METHODS:
Before operation, 113 patients underwent the modified Allen test, Doppler ultrasonography, and pulse oximetry testing. Morphologic criteria used for radial artery exclusion were small size of radial or ulnar artery (< 2 mm in inner diameter), diffuse calcifications, and congenital anomalies of forearm arteries. Collateral circulation was interpreted as insufficient if the reverse flow in the anatomic snuffbox was absent or if the increase of the ulnar peak systolic flow velocity was less than 20%.

RESULTS:
A positive modified Allen test was found in 10.6% of patients. As assessed by Doppler ultrasonography, 27 patients (23.9%) were not candidates for radial artery harvesting according to morphologic and functional abnormalities of forearm and hand circulation. Pulse oximetry test results were abnormal in 6.2%. After a follow-up period of 8.9 +/- 1.8 months, 23 patients (29.1% of operated patients) were controlled for Doppler ultrasonographic changes in the ulnar artery. The mean peak systolic flow velocity was significantly higher than the preoperative value measured at rest (p < 0 .001).

CONCLUSIONS:
After preoperative tests, including the modified Allen test, Doppler ultrasonography, and pulse oximetry, 30.1% of patients were not considered candidates for radial artery harvesting. This method provides preoperative radial artery selection according to its morphologies, compensatory capacity of collateral circulation, and anatomic properties of ulnar artery.

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Author information

Author/s: Vukovic, Petar M (PM); Radak, Sandra S (SS); Peric, Miodrag S (MS); Nezic, Dusko G (DG); Knezevic, Aleksandar M (AM);

Affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia. petarvuk(-atsign-)eunet.yu

Journal and publication information

Publication Type: Journal Article

Journal: The Annals of thoracic surgery (Ann Thorac Surg), published in Netherlands. (Language: eng)

Reference: 2008-Sep; vol 86 (issue 3) : pp 828-31

Dates: Created 2008/08/25; Completed 2008/09/19; Revised 2008/09/22;

PMID: 18721569, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Middle Aged
Oximetry
Radial Artery - anatomy & histology; transplantation
Tissue and Organ Harvesting - methods
Ulnar Artery - anatomy & histology
Ultrasonography, Doppler

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