The role of preoperative radial artery ultrasound and digital plethysmography prior to coronary artery bypass grafting.
OBJECTIVE
Doppler ultrasound and digital plethysmography are used at our institution to determine the suitability of the radial artery for harvest prior to coronary artery bypass grafting (CABG). The purpose of this study is to determine the value of this preoperative evaluation.


METHODS
A retrospective analysis of non-invasive radial artery testing was performed on 187 CABG patients. Criteria used to exclude radial arteries from harvest were anatomic abnormalities (size<2 mm, diffuse calcifications), and perfusion deficits during radial artery occlusion (>40% reduction in digital pressure, non-reversal of radial artery flow, or minimal increase in ulnar velocity). A questionnaire was used to determine the incidence of postoperative hand ischemia or rehabilitation.


RESULTS
In 187 patients, 346 arms were evaluated. Ninety-four arms (27.1%) were excluded for harvesting. Anatomical abnormalities included size<2 mm (1.5%), diffuse calcifications (8.7%), congenital anomalies (2.3%), and radial artery occlusion (0.3%). Circulatory abnormalities included non-reversal of flow (7.2%), abnormal digital pressures (5.5%), and inappropriate increase in ulnar velocity (1.7%). A total of 116 radial arteries were harvested. There were no episodes of hand ischemia. No patient required hand rehabilitation. CONCLUSIONS Doppler ultrasound and digital plethysmography identifies both perfusion (14.5%) and anatomical (12.7%) abnormalities that may make the radial artery less suitable as a bypass conduit.
Rodriguez
E
E
Department of Cardiothoracic Surgery, Jefferson Medical College, Suite 607, 1025 Walnut Street, Philadelphia, PA 19107, USA.
Ormont
M L
ML
Lambert
E H
EH
Needleman
L
L
Halpern
E J
EJ
Diehl
J T
JT
Edie
R N
RN
Mannion
J D
JD
D003097:Collateral Circulation; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000637:transplantation; D012039:Regional Blood Flow; D014463:Ultrasonography