title: Is radial artery Doppler scanning mandatory for use as coronary bypass conduit?
abstract: BACKGROUND
  Screening of the radial artery prior to harvesting as a conduit for coronary bypass may be performed clinically by the Allen test or by Doppler ultrasound. In a developing country like ours, the use of resources for Doppler studies may be questioned when Allen tests lead to a low rate of clinical sequelae. However, the rare occurrence of hand ischemia may be devastating and could justify the routine use of Doppler screening. This study aimed to address this question.
  
  
  METHODS
  One hundred patients undergoing elective coronary artery bypass grafting were screened by the modified Allen test and Doppler ultrasound for suitability of use of a radial artery conduit. After harvesting, proximal and distal segments of the radial artery were subjected to histopathological examination.
  
  
  RESULTS
  Of the 95 patients deemed suitable for radial artery grafting, 6 had mild calcification on Doppler ultrasound and 9 had calcification on histopathological examination. While Doppler showed atherosclerosis in 9 patients, only 6 had histopathological evidence of this (false-positive rate 3%). Of the 6 patients with histopathologic evidence of atherosclerosis, 2 were negative on Doppler (false-negative rate 2%).
  
  
  CONCLUSIONS
  Routine preoperative Doppler screening of the radial artery in the setting of limited resources is not justified. On the other hand, the time-tested Allen test which is easy to perform, interpret, and reproduce can be safely used as the sole screening test to harvest the radial artery.
authors.affiliation: National Heart Institute, New Delhi, India.
authors.forename: Om Prakash
authors.initials: OP
authors.lastname: Yadava
authors.affiliation: National Heart Institute, New Delhi, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Dinda
authors.affiliation: National Heart Institute, New Delhi, India.
authors.forename: Bikram K
authors.initials: BK
authors.lastname: Mohanty
authors.affiliation: National Heart Institute, New Delhi, India.
authors.forename: Rekha
authors.initials: R
authors.lastname: Mishra
authors.affiliation: National Heart Institute, New Delhi, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Ahlawat
authors.affiliation: National Heart Institute, New Delhi, India dockundu@yahoo.com.
authors.forename: Anirban
authors.initials: A
authors.lastname: Kundu
mesh_terms: D050197:Atherosclerosis / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D003097:Collateral Circulation; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery; D017046:Cost Savings; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007194:India; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods; D018608:Ultrasonography, Doppler / Q000191:economics / Q000379:methods
keywords: Collateral circulation; coronary artery bypass; hand; pathology; radial artery; tissue and organ harvesting