Evaluation of the forearm blood flow with C.W. Doppler in patients submitted to myocardial revascularization with the radial artery

Abstract

Before harvesting the radial artery for coronary bypasses, investigating forearm vascularization to avoid postoperative ischemia of the hand is mandatory. The study involved 192 consecutive patients, 155 males and 37 females age 39–76 years (mean 56.1). The CW Doppler static and dynamic test was performed to evaluate the patency of the upper limb's arteries and the adequacy of the ulnar supply in the nondominant arm. The use of the radial artery was contraindicated in 14 patients (3 for stenosis of the subclavian artery and 11 for inadequate collateralization). One hundred and four patients were operated on with the radial artery used as a graft; another conduit was used in the remaining 74 patients. The vascularization of the hand was restudied within 10 days in all patients who underwent surgery; in 82 patients, it was studied again at 1 year. The early Doppler control showed a significant increase of blood flow velocities in the ulnar artery, with a flow redistribution in the common digital palmar arteries (decreased in the 1st and slightly increased in the 3rd). The late Doppler control showed superimposable findings. No local ischemic complications were observed after radial artery removal. Three patients showed thumb dysesthesias with no functional damage, probably due to surgical trauma of the radial nerve collateral branches. The authors conclude that a Doppler study is a useful tool to detect patients for radial artery surgical removal and to predict the efficacy of the ulnar supply through the distal anastomosis.