The role of preoperative radial artery ultrasound and digital plethysmography prior to coronary artery bypass grafting

Objective: Doppler ultrasound and digital plethysmography are used at our i nstitution to determine the suitability of the radial artery for harvest pr ior to coronary artery bypass grafting (CABG). The purpose of this study is to determine the value of this preoperative evaluation. Methods: A retrosp ective analysis of non-invasive radial artery testing was performed on 187 CABG patients. Criteria used to exclude radial arteries from harvest were a natomic abnormalities (size < 2 mm, diffuse calcifications), and perfusion deficits during radial artery occlusion (>40% reduction in digital pressure , non-reversal of radial artery flow, or minimal increase in ulnar velocity ). A questionnaire was used to determine the incidence of postoperative han d ischemia or rehabilitation. Results: In 187 patients. 346 arms were evalu ated. Ninety-four arms (27.1%) were excluded for harvesting. Anatomical abn ormalities included size < 2 mm (1.5%), diffuse calcifications (8.7%), cong enital anomalies (2.3%), and radial artery occlusion (0.3%). Circulatory ab normalities included non-reversal of flow (7.2%), abnormal digital pressure s (5.5%), and inappropriate increase in ulnar velocity (1.7%). A total of 1 16 radial arteries were harvested. There were no episodes of hand ischemia. No patient required hand rehabilitation. Conclusions: Doppler ultrasound a nd digital plethysmography identifies both perfusion (14.5%) and anatomical (12.7%) abnormalities that may make the radial artery less suitable as a b ypass conduit. (C) 2001 Elsevier Science B.V. All rights reserved.