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J Thorac Cardiovasc Surg 1996;112:737-744
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

SAFE REMOVAL OF THE RADIAL ARTERY FOR MYOCARDIAL REVASCULARIZATION: A DOPPLER STUDY TO PREVENT ISCHEMIC COMPLICATIONS TO THE HAND

Paolo Pola, MDa, Michele Serricchio, MDa, Roberto Flore, MDa, Eric Manasse, MDb, Angela Favuzzi, MDa, Gian Federico Possati, MDb

Received for publication Dec. 14, 1995 Revisions requested Jan. 15, 1996; revisions received March 4, 1996 Accepted for publication March 19, 1996. Address for reprints: Paolo Pola, MD, Primario del Servizio di Angiologia, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy.

Abstract

Radial artery harvesting has recently been reintroduced for myocardial revascularization. Harvesting the radial artery may jeopardize the vascularization of the hand; cautious selection of candidates must therefore be pursued. The study involved 188 consecutive patients. We verified the patency of the upper limb's arteries and the adequacy of the ulnar supply by static and dynamic Doppler evaluations. The use of the radial artery was contraindicated in 14 cases (three for stenosis of the subclavian artery and 11 for inadequate collateralization). One hundred patients were operated on with the radial artery used as a graft; the remaining 74 patients had a different conduit placed. The vascularization of the hand was restudied within 10 days in all patients who underwent operation; in 63 patients, it was studied again at 1 year. The early Doppler examination showed significant increase in blood flow velocities in the ulnar artery, with a flow redistribution in the common digital palmar arteries (decreased in the first and increased in the second and the third). The late Doppler examination showed superimposable findings. No local ischemic complications were observed. We conclude that Doppler study is a useful tool in preoperative screening of candidates for radial artery harvesting for myocardial revascularization. (J THORACCARDIOVASCSURG1996;112:737-44)




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