Original article: cardiovascular
Digital blood flow after radial artery harvest for coronary artery bypass grafting

https://doi.org/10.1016/j.athoracsur.2003.11.030Get rights and content

Abstract

Background

Despite widespread use of radial artery as a bypass conduit in coronary artery bypass surgery, flow readjustment that takes place in the hands and fingers after the removal of the radial artery is poorly understood.

Methods

Using pulse volume recording plethysmography, a semiquantitative measurement of digital blood flow was carried out in 24 patients 7 days after harvesting of radial artery for coronary artery bypass grafting. Measurements taken from the fingers of the operated arms were evaluated and compared with those taken from the opposite or the control arms.

Results

Postoperatively, there was an overall decrease in blood flow to all the fingers of the operated arms. At the same time, there was evidence of redistribution of digital blood flow favoring the first two fingers over the last two, the same distribution pattern as seen in the fingers of the control arms. The pulse amplitude studies, likewise, showed a significant drop in all fingers of the operated arms, with the decrease most pronounced in the fourth and fifth fingers. None of the patients showed signs of digital ischemia postoperatively.

Conclusions

The study showed that there was an overall decrease in digital blood flow after radial artery harvesting. The resulting blood supply by way of the remaining ulnar artery still provided more flow to the first two fingers over the last two fingers, indicating the existence of an autoregulatory mechanism operating to satisfy the physiologic needs of the fingers.

Section snippets

Patients and methods

Twenty-four patients, 18 male and 6 female, with a mean age of 59.8 ± 7.6 years, were studied 7 days after the operation. In 10 volunteers, blood flow in both arms was measured and compared with establish the validity of using the opposite or the nonoperated arms as controls.

Results

In 10 volunteers, the pulse morphology and amplitude studies failed to show significant difference in the brachial, forearm, wrist, and all the fingers between the dominant and nondominant arms, making it possible for us to use the dominant (nonoperated) arms as controls (Table 1).

The pulse morphology was divided into three general categories: normal, no reflected wave, and blunted wave forms, each representing normal, intermediate, and minimum blood flow (Fig 1). The distribution of each

Comment

Evaluation of the blood flow of the hand and fingers is difficult because of the dual arterial supply and the complex and inconsistent anastomosing branches. Coleman and Anson [19] stated that a complete arch is present in about 80% of cases and, in the remaining 20%, the collateral flow between the ulnar and radial systems may be inadequate. Ruengsakulrach and associates [20], in a study of 50 cadaver hands, reported that superficial palmar arch of the ulnar artery supplied flow to all fingers

Acknowledgements

We thank Drs S. H. Cho and K. C. Tark for their insightful comments in preparing this article. We are also grateful to Dr P. W. Hong for reviewing this article.

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    Copyright © 2004 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.