Can Ulnar Artery Velocity Changes Be Used as a Preoperative Screening Tool for Radial Artery Grafting in Coronary Artery Bypass?

Late haemodynamic and functional consequences of radial artery removal on the forearm circulation

“…Actually, the excellent clinical and angiographic results reported have definitely ruled out the perplexities related to the long term durability of this conduit [1,2,7,8] and even the immediate consequences of radial artery harvesting on the forearm blood supply and the methods to minimize the incidence of acute hand ischemia have been clearly established [3][4][5][6]. However, to date few series have evaluated the long term haemodynamic consequences of RA harvesting for CABG [9,10].…”

“…For this reason several methods of preoperative assessment of the adequacy of ulnar artery compensation have been proposed [3][4][5][6]; using these strategies the incidence of acute forearm ischemic events has been minimized and is actually reported to be nearly zero in most of the published series [2,7,8].…”

Radial Artery Cannulation: A Systemic Review

“…This test is similar to the test performed in the lower extremities and involves placement of cuffs around the forearm, upper elbow and wrist and measuring pressures by Doppler and recording waveforms at these levels. A pressure difference of more than 15Hgmm is suggestive of a hemodinamically significant stenosis [19].…”

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

“…Sullivan et al have reported no correlation between ulnar artery velocity changes and digit pressure change during radial artery compression in 40 normal subjects. 32 They concluded that velocity changes cannot be used to determine potential digit ischemia following radial artery harvesting and therefore recommend using digital pressure measurement with radial artery compression as the preoperative screening tool prior to radial artery harvest.…”

“…10 Circulatory contraindications include the absence of flow reversal in the radial artery during radial artery compression or < 20% increase of ulnar peak systolic flow during radial artery compression. 32,33 Contraindication by plethysmography includes a > 40% decrease in digital pressure during radial artery compression. When there is a contraindication for radial artery harvest in the non-dominant hand, the risk of having a non-harvestable artery in the dominant hand is doubled.…”