Long-term palmar microcirculation after radial artery harvesting: an observational study.
BACKGROUND
The aim of this study was to assess palmar microcirculation in a long-term follow-up after radial artery harvesting for coronary revascularization.


METHODS
One hundred fourteen patients (100 male; aged 61.7 +/- 6.7 years; preoperative New York Heart Association 2.3 +/- 0.6, ejection fraction 61.4% +/- 13.9%) were included after undergoing elective coronary revascularization using the radial artery of the nondominant forearm with a nonpathologic Allen's test. Superficial and deep tissue oxygen saturation (SO2), postcapillary venous filling pressure (rHb), capillary blood flow, and capillary blood flow velocity were determined at a mean 25 +/- 5 months after surgery using a combined laser Doppler spectrophotometry system.


RESULTS
At 2-mm tissue depth, there was a small, but significant, decrease of 3% of superficial SO2 at the thumb and the thenar eminence (D1: 75.3% +/- 8.9% versus 77.6% +/- 9.7%, p = 0.003; thenar: 71.5% +/- 10.5% versus 73.2% +/- 8.2%, p = 0.027). Deep palmar SO2 was changed significantly at 5 of 7 positions by 3%. Deep postcapillary venous filling pressure (8 mm) was significantly increased by 9% only at the fingertip of the fifth finger (112.4 +/- 49.7 versus 103.0 +/- 25.0, p = 0.033), while superficial capillary blood flow decreased by 13% at only 1 of 7 positions at the hypothenar eminence (242.0 +/- 153.6 versus 275.6 +/- 169.2, p = 0.009). Overall, only 2 of 56 positions exceeded a given threshold of 5% change of microcirculation. No clinical signs of malperfusion were found (postoperative New York Heart Association 1.1 +/- 0.4, p < 0.05), and no patient was impaired in daily palmar motor activity.


CONCLUSIONS
Long-term objective evaluation of superficial and deep palmar microcirculation confirms that radial artery harvesting for coronary revascularization does not compromise palmar microcirculation.
Knobloch
Karsten
K
Thoracic and Cardiovascular Surgery, Medical School Hannover, Hannover, Germany. kknobi@yahoo.com
Tomaszek
Sandra
S
Lichtenberg
Artur
A
Karck
Matthias
M
Haverich
Axel
A
D000368:Aged; D001783:Blood Flow Velocity; D015992:Body Mass Index; D002196:Capillaries / Q000502:physiology; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017534:Radial Artery / Q000601:surgery*; D012039:Regional Blood Flow; D012307:Risk Factors; D020858:Tissue and Organ Harvesting
D010100:Oxygen