Non-harvestable radial artery. A bilateral problem?

Abstract

Since radial artery is preferably harvested from a non-dominant hand, our aim was to study whether there are contraindications for radial artery harvest in the dominant hand if the radial artery of the other hand is not suitable for harvesting. Thirty-three patients scheduled to coronary artery bypass grafting with contraindication for radial artery harvest in the non-dominant hand underwent Allen test, upper arm Doppler ultrasonography and digital pletysmography. In ultrasonography, both anatomical and circulatory measurements were performed. Both hands were then compared to each other. Furthermore, twelve control patients without contraindication for radial artery harvest in the non-dominant hand were examined. All 33 patients had contraindication for radial artery harvest in the non-dominant hand. Twenty-four (73%) had contraindication in the dominant hand as well. In terms of morphology, there was no statistically significant difference between the hands but circulatory parameters as a group suggested contraindication. Among controls, four patients (33%) had contraindication in the dominant hand. In the case of a non-harvestable radial artery in a hand there is clearly an increased risk for contraindication for radial artery harvest also in the other hand.

Prevalence, risk factors, and clinical correlates of ulnar artery occlusion in the general population

“…Nevertheless, the specificity of the clinical Allen test remains high in these conditions, ranging from 91% to 97.1%, 6,12,13 whereas some authors found the sensitivity was as low as 54.5%. 13 A specificity of 91% can be too low in the context of a decision-making process when applied to the prediction of the outcome of an aggressive procedure in single patients, but it is already quite high when the information is used as an epidemiologic marker for group comparisons.…”

“…[3][4][5][6][7][11][12][13][14][15] However, the sensitivity and specificity of the Allen test for the occlusion of the ulnar artery was quite high, at 95% and 100%, respectively, for Hirai et al 21 compared with arteriography in 192 hands, and was 96% and 97%, respectively, for Pistorius et al 8 in a series of 576 patients with Raynaud phenomenon with a plethysmographic test as reference.…”

“…1 The Allen test is mainly used nowadays in the preoperative assessment of ulnar artery patency in patients undergoing coronary procedures endangering or harvesting the radial artery. [2][3][4][5][6][7] It is also a cornerstone of the clinical examination of patients with Raynaud phenomenon, in whom it is used for the etiologic diagnosis, because the evidence of an associated distal arterial disease of the upper limbs excludes a primary Raynaud diagnosis. [8][9][10] Several studies using the Allen test in patients undergoing coronary interventions have shown a substantial prevalence of ulnar artery occlusion, most often evaluated on the nondominant hand, with a median of about 12% (range, 5.6%-27%).…”

Is radial artery Doppler scanning mandatory for use as coronary bypass conduit?

“…The modified AT has also been validated by Ruengsakulrach and colleagues 7 using a 10-s cutoff, similar to that used in our series. Glavin and Jones 8 and Kohonen and colleagues 9 confirmed the safety and efficacy of the modified AT and failed to establish any benefit of Doppler USG in assessing the adequacy of collateral flow in the hand. Although postoperative hand ischemia has been reported when the AT alone was used to assess collateral circulation in the hand, 10 complications have occurred even after USG examination, 11 which therefore does not provide 100% safety.…”

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

“…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. 28 Patients with hand ischemia after radial artery harvest can present with a variety of symptoms ranging from hand fatigue, to resting pain and gangrene. Severe ischemia has been reported to develop in up to 0.03%, whereas mild ischemia may develop in up to 10%.…”