Assessment of collateral circulation to the hand prior to radial artery harvest

Habib, Joseph; Baetz, Laureen; Satiani, Bhagwan

doi:10.1177/1358863x12451514

Cited by 60 publications

(53 citation statements)

References 34 publications

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“…A modified Allen’s test is defined as a normal capillary response in the hand in less than 7 to 10 seconds after relief of digital compression of the ulnar artery during a strong fist grip emptying the hand of blood [50]. …”

Section: Methods and Designmentioning

confidence: 99%

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

Carranza

Ballegaard

Werner

et al. 2014

Trials

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BackgroundCoronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique.Methods/DesignThe NEO Trial is a randomised clinical trial with a 2 × 2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively.We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory.Trial registrationClinicalTrials.gov identifier: NCT01848886.Danish Ethics committee number: H-3-2012-116.Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838.

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Section: Methods and Designmentioning

confidence: 99%

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

Carranza

Ballegaard

Werner

et al. 2014

Trials

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“…Clinical role of collaterals from the interosseous artery: In previous reports, communication between distal radial and ulnar arteries with the palmar arch was emphasized because blood supply could be maintained once either forearm artery became occluded. 12) Actually, during ulnar artery cannulation, distal ulnar arterial flow will be compromised or obstructed by the indwelling arterial sheath, as shown in Figure 1. No vascular complication was observed in our patients who tolerated the procedure even in CTO interventions involving prolonged bilateral forearm cannulation ≤ 260 minutes.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion

et al. 2017

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SummaryTo investigate the postprocedural cardiovascular events and vascular outcomes, including hand ischemia and neurological compromise, after transulnar (TU) catheterization in ipsilateral radial artery occlusion.Previous randomized trials have shown that the transulnar (TU) approach for coronary angiogram and intervention has safety and outcomes similar to those of the transradial (TR) approach. However, the safety of the TU procedure when ipsilateral radial artery occlusion occurs is unknown.We retrospectively reviewed 87 TU cases with ipsilateral radial artery occlusion confirmed by a forearm angiogram. Eighty percent of these patients had a history of ipsilateral radial artery cannulation or surgery. We avoided the use of over-sized sheaths or applied a sheathless approach during surgery.No ulnar artery occlusion was observed by subsequent Doppler ultrasound or pulse oximetry. No patient developed hand ischemia or serious complications requiring surgery or blood transfusion during the follow-up period of 32.2 ± 24.0 months. Review of the preprocedural forearm angiograms showed that 95.7% of the patients possessed significant collaterals supplying flow from the interosseous artery to the occluded radial artery remnant. Thus, the blood circulation to the palmar arch and digital vessels was maintained even when the ulnar artery was temporarily occluded by an in-dwelling ulnar arterial sheath.TU catheterization was safe in patients with coexisting ipsilateral radial artery occlusions and feasible for use in complex intervention procedures. Cautious manipulation of ulnar artery cannulation and hemostasis helped decrease the risk of hand ischemia. ( and intervention is superior to the transbrachial and transfemoral approaches, with a lower complication rate and better patient tolerance.1,2) Ulnar artery cannulation has anatomical advantages similar to those of radial artery cannulation, such as an easier approach to the wrist portion and better patient compliance for hemostasis. Although there is less anatomical variation and vasospasm in the ulnar artery than in the radial artery, its deeper location and nearby ulnar nerve increases the difficulty of puncture and complication rate.3) To investigate the safety of transulnar (TU) coronary catheterization, limited randomized trials have compared the major adverse cardiovascular (CV) events and major vascular complications between the radial and ulnar artery approaches.4-7) The TU approach has success rates for arterial puncture and coronary intervention similar to those of the TR approach without increasing entry site complications, including arterial occlusion. However, Hahalis, et al have reported not only the relative inferiority of the cross-over rate in the TU access route but also significantly higher puncture trials, longer puncture and fluoroscopy times, and higher amounts of contrast medium in TU patients than in TR patients. 6) Thus, the ulnar artery is recommended as an alternative access site only if the radial arterial approach fails or is not feasib...

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“…We also used the absence of documented Doppler flow in the ulnar as the gold standard for inadequate ulnar collateral supply. In addition to static testing, methods that employ dynamic assessment of Doppler signals during radial artery compression have been described; 22 however, none of these techniques are associated with better prognostication of adequate collateral flow, and thus we elected to use the most extreme case (i.e., absence of flow) as our standard. Further more, all testing was performed by the same coinvestigator, which predisposed our study to verification bias; however, ran domly assigning participants to either the heart rate-monitoring application or the modified Allen test for the initial assessment and then comparing the result to our reference standard was important in mitigating this bias.…”

Section: Limitationsmentioning

confidence: 99%

Photoplethysmography using a smartphone application for assessment of ulnar artery patency: a randomized clinical trial

Santo¹,

Harnett²,

Simard³

et al. 2018

CMAJ

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Assessment of collateral circulation to the hand prior to radial artery harvest

Cited by 60 publications

References 34 publications

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2 × 2 factorial designed randomised NEO trial

Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion

Photoplethysmography using a smartphone application for assessment of ulnar artery patency: a randomized clinical trial

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