Preoperative Insight Into the Quality of Radial Artery Grafts

Abstract

We investigated the impact of preoperative ultrasonography of the forearm circulation on radial artery conduit selection. Preoperative ultrasound of the forearm circulation was performed routinely in 536 patients planned for radial artery harvesting. The safety assessment of the harvest included the following algorithm of tests: the ultrasound, the Allen test, and pulse oximetry. The quality criteria that were used to exclude a radial artery from harvesting were small size of the artery, diffuse atherosclerosis, calcifications, and severe neointimal hyperplasia. The overall rejection rate due to safety reasons was 16.4%. Seventy-one (13.2%) radial arteries did not fulfill the conduit quality criteria and consequently these arteries were not harvested. In 13.4% of radial arteries, localized arterial wall disease was found in the distal third of the artery. The distal part of the artery was discarded and the rest was used as a conduit. Our results indicate that the ultrasound provides an accurate preoperative insight into the radial artery morphology, enabling selection of the arteries with favorable morphological features.

Is the result of modified Allen’s test still accurate after endoscopic thoracic sympathectomy?

“…To serve as a bridging vessel, the RA needs to be examined by MAT before CABG. The safety assessment of the harvest includes the following algorithm of tests: ultrasound, the Allen's test, and pulse oximetry (22). The quality criteria that are used to exclude a RA from harvesting are small size of the artery, diffuse atherosclerosis, calcifications, and severe neointimal hyperplasia (22).…”

First, do no harm: bilateral radial artery occlusion in a COVID-19 patient

“…• To test collateral arterial supply of the hand, a pulseoximeter was placed on the index finger. Thereafter, the ulnar artery at the wrist was compressed [4]. This compression caused an immediate loss of the finger's pulseoximetry perfusion signal.…”

“…Since COVID-19 patients are at increased risk for arterial occlusion, it appears advisable to meticulously check for adequacy of collateral (hand-) perfusion [4], avoiding the harm of hand ischemia if interventions (e.g., catheterizations) at the radial or ulnar artery are intended.…”

Sounds Good—A Sonographic Approach for Dealing With a Rising Vascular Problem

“…In a previous issue of Angiology , Vukovic et al 1 report on the preoperative ultrasonic assessment of the radial artery for use as a conduit for coronary artery bypass graft (CABG).…”

“…The concept applied in the study of Vukovic et al 1 is logical. A sonographically guided preselection of radial arteries for coronary grafts using clear ultrasonic criteria is an excellent idea.…”