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Abstract
The long-term success of coronary artery bypasses grafting remains dependent on continued graft patency. In comparison with standard saphenous vein grafts, the use of the internal thoracic artery has obtained superior long-term results, with improved patient survival. This suggests that further benefit may be gained from a strategy of total arterial revascularization.
Recently, the radial artery is becoming a preferred conduit for coronary bypass surgery since modification of the harvesting technique, and the administration of antispasmodic drugs, increased patency to more than 95% compared to about 50 % patency rate when radial artery was first used as a graft.
In general, the radial and ulnar arteries form a dual blood supply to the hand; this makes it increasingly important to identify those patients who can have the radial artery safely removed without consequent hand ischemia.
Aim of this study was to review methods of Perioperative assessment of hand circulation in patients submitted to myocardial revascularization with the radial artery, including the Allen’s test, pulse oximetry and Doppler ultrasound examination.
Doppler examination can demonstrate anatomic variations of the palmar circulation, allows the identification of atherosclerotic lesions of arteries of the upper limb and determine the patency of ulnar collateral circuit during compression of the radial artery.
In conclusion, safe radial artery removal for coronary bypass surgery is better ensured in the absence of atherosclerotic lesions of the upper limb arteries, and of anatomic variations of the palmar circulation and in the presence of a competent ulnar collateral blood supply to the hand. Doppler ultrasound is a worthwhile and safer tool to verify these conditions.