Oxygen pressure measurement during grip exercise reveals exercise intolerance after radial harvest.
BACKGROUND
Exercise intolerance of the hand after harvest of the radial artery is not well understood, although mild reductions of blood flow to the hand are reported. To ascertain its prevalence, patient symptoms implying potential exercise intolerance were evaluated by measuring transcutaneous oxygen pressure of the hand during grip exercise. For ascertaining predictive values, we verified ulnar flow reserve measured by Doppler ultrasonography before the harvest of radial artery.


METHODS
Forty patients whose radial artery was harvested for coronary bypass graft, were interviewed and tested 1 year after operation, and their preoperative ultrasonographic data compared.


RESULTS
Five patients (12.5%) had mild symptoms implying exercise intolerance. Exercise tests revealed severe decreases in tissue oxygenation in 7 patients (17.5%), but in accordance with symptoms (p = 0.0018). Tissue oxygenation in the operated hand was lower than in the nonoperated even in asymptomatic patients (p = 0.0011). Preoperative Doppler echography revealed that ulnar arteries of symptomatic patients were smaller (p = 0.0019) and carried lower blood flows during manual compression of the radial artery (p = 0.0004) compared with those of asymptomatic patients. Smaller ulnar arteries (less than 1.4 mm/m(2)) with poor flow reserves (less than 60 mL x min(-1) x m(-2) during radial compression) appear to indicate risks for exercise intolerance (p = 0.0004).


CONCLUSIONS
More than 10% of patients after harvest of radial arteries had mild symptoms implying exercise-intolerance, which accorded with abnormal tissue oxygenation during grip exercise. Work habits of patients should be considered in radial harvest decisions, especially if preoperative Doppler echography indicates lower flow reserves for the ulnar artery.
Manabe
Susumu
S
Department of Cardiothoracic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Tabuchi
Noriyuki
N
Toyama
Masaaki
M
Yoshizaki
Tomoya
T
Kato
Masanori
M
Wu
Haisong
H
Kotani
Mitsuhisa
M
Sunamori
Makoto
M
D001783:Blood Flow Velocity; D001785:Blood Gas Monitoring, Transcutaneous; D001026:Coronary Artery Bypass; D017079:Exercise Tolerance; D005260:Female; D006225:Hand / Q000098:blood supply; D018737:Hand Strength; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D017534:Radial Artery / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D017535:Ulnar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D018608:Ultrasonography, Doppler
D010100:Oxygen