Hand perfusion with 99mTc-HSA in patients expecting to undergo coronary bypass surgery: elaboration of a new complex diagnostic protocol for the safe removal of a radial artery graft.
BACKGROUND
The Allen test is used worldwide for radial artery graft removal. The postoperative examination of our patients' hand function and circulation proved that beside the transient neurological complications chronic hand circulatory disorders may arise.


OBJECTIVE
To develop a non-invasive method suitable for an objective evaluation of the hand's circulation to make it possible to use radial arteries safely for the revascularization of coronary arteries.


METHODS
We examined 35 patients. After selective compression of the radial and ulnar arteries of both hands, we injected 400 MBq (99m)Tc-HSA intravenously and acquired 240 images, each of 1 s. After 30 s we released the ulnar artery first, and after 120 s the radial artery, too. Then computer analysis was performed.


RESULTS
The patients could be divided into two groups. In the majority of them, releasing only the ulnar artery resulted in a good circulation of the fingers. It meant that the time-activity curve rapidly reached its maximum, and the activity did not change even after releasing the radial artery. In a smaller proportion of the patients the activity of the fingers increased only slowly, and did not reach a plateau even after 30 s. Following the release of the radial artery a further increase in the activity could be observed. We assume that the latter patient group is at risk of consequent circulatory disorder of the fingers after the removal of the radial artery, whereas in the former group the artery could be removed safely.


CONCLUSIONS
Hand perfusion with (99m)Tc-HSA is useful in patients selected for coronary bypass operations, so we recommend the introduction of this method as a routine examination before the removal of the radial artery in patients with an abnormal Allen test.
Garai
Ildikó
I
University of Debrecen, Hungary. garai@internal.med.unideb.hu
Csiki
Zoltán
Z
Varga
József
J
Galuska
László
L
Patonay
Lajos
L
Szabados
Lajos
L
Péterffy
Arpád
A
Galajda
Zoltán
Z
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006225:Hand / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D017534:Radial Artery / Q000637:transplantation*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow / Q000502:physiology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013668:Technetium Tc 99m Aggregated Albumin
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin