Upper extremity hemodynamic changes after radial artery harvest for coronary artery bypass grafting.
Twenty-seven patients were studied with arterial duplex, photoplethysmography, segmental pressures, and pulse volume recordings both preoperatively and following radial artery harvesting. The average number of days to the follow-up visit was 66. Preoperative and postoperative data were compared using the matched Student's t-test. There were no significant changes between preoperative and postoperative pressures in the brachial, radial, and ulnar arteries, and thumb, index, long, ring, or little fingers. Pressure changes in the thumb and index finger approached but did not achieve a statistical difference. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) in the distal ulnar artery changed significantly between preoperative and postoperative measurements. PSV changed from 0.50 +/- 0.05 m/sec to 0.67 +/- 0.04 m/sec (p = 0.02); EDV changed from 0.03 +/- 0.03 m/sec to -0.10 +/- 0.05 m/sec (p = 0.05); and RI changed from 0.97 +/- 0. 05 to 1.13 +/- 0.05 (p = 0.02). Palmar arch evaluations revealed significant changes at rest and with ulnar compression between preoperative and postoperative measurements: (1) at rest EDV changed from 0.03 +/- 0.02 m/sec to -0.05 +/- 0.02 m/sec (p < 0.01); (2) at rest RI changed from 0.96 +/- 0.05 to 1.12 +/- 0.05 (p = 0.01); (3) with ulnar compression the PSV changed from 0.23 +/- 0.05 m/sec to 0. 005 +/- 0.01 m/sec (p < 0.01); and (4) with ulnar compression the RI changed from 0.82 +/- 0.11 to 0.27 +/- 0.12 (p < 0.01). Eight patients had a variety of complaints at the follow-up visit, the majority being numbness and tingling. No patients reported symptoms of claudication or rest pain at the follow-up visit. The data suggest that while statistically significant changes in velocity and arterial resistance do occur, patients seem to tolerate radial artery harvesting without clinical consequences. The ideal method of preoperative evaluation remains to be determined.
Lohr
J M
JM
John J. Cranley Vascular Laboratory, Good Samaritan Hospital, Cincinnati, OH 45220-2489, USA.
Paget
D S
DS
Smith
J M
JM
Winkler
J L
JL
Wladis
A R
AR
D000368:Aged; D001132:Arm / Q000098:blood supply*; D001783:Blood Flow Velocity; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005385:Fingers / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D017534:Radial Artery / Q000637:transplantation*; D012039:Regional Blood Flow; D014182:Transplantation, Autologous; D014655:Vascular Resistance