Laser Doppler flowmetry assessment of microcirculation in upper extremities before and in long-term period after harvesting of radial artery.
Radial artery (RA) is rather commonly used as a graft for autoarterial myocardial revascularization. Consequences of RA harvesting for the development of ischemic disturbances in distal hand segments are poorly understood. The paper presents assessment of hand microcirculation (HMC) before and in late postoperative period after RA harvesting with modern precise diagnostic method - laser Doppler flowmetry (LDF). LDF assessment of HMC was carried out in 80 patients with ischemic heart disease (160 hands) to evaluate the possibility of RA harvesting for coronary artery bypass surgery. HMC classification was developed on the base of these measurements: type 1 -normocirculatory HMC: 6.7-17 ml/min/100 g (58%); type 2 - vasospastic HMC: < or = 6.7 ml/min/100 g (20%); type 3 - hyperemic HMC: > or = 17 ml/min/100 g (22%). In 34% of cases preoperative examination revealed microcirculatory asymmetry between right and left hands. Based on preoperative examination results in 22.9% of cases the decision was made to refuse from RA excision because of positive collateral circulation test developed in our Institute (positive decision about Patent award according to appeal No2000122582/14 (023905) from 28.08.2000). In 14 patients (14 upper extremities) HMC was measured before and 1-1.5 years after RA harvesting. After RA excision baseline HMC in operated hand reduced significantly while maximal HMC reserve remained at the level close to preoperative one. Postoperative HNMC alterations evidence of adequate preoperative assessment of hand collateral circulation potential. In case of blood flow asymmetry RA must be taken from the hand with higher blood supply and adequate collateral microcirculation.
Cherniavskiĭ
A M
AM
E. N. Meshalkin Research Institute of Circulation Pathology, Novosibirsk, Russia. amchern@mail.ru
Okuneva
G N
GN
Al'sov
S A
SA
Bulatetskaia
L M
LM
D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D003097:Collateral Circulation / Q000502:physiology; D001026:Coronary Artery Bypass; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000637:transplantation*; D020858:Tissue and Organ Harvesting; D014463:Ultrasonography; D034941:Upper Extremity / Q000098:blood supply*