Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting

Objective: Radial artery harvesting for coronary artery bypass may lead to digit ischemia if collateral hand circulation is inadequate. The modified Allen's test is the most common preoperative screening test used. Unfortunately, this test has high false-positive and false-negative rates. The p...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 1999-02, Vol.117 (2), p.261-266
Main Authors: Starnes, Sandra L., Wolk, Seth W., Lampman, Richard M., Shanley, Charles J., Prager, Richard L., Kong, Bobby K., Fowler, Jennifer J., Page, Jeanne M., Babcock, Shelly L., Lange, Leslie A., Erlandson, Errol E., Whitehouse, Walter M.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Blood Pressure Determination - instrumentation
Blood Pressure Determination - methods
Blood Pressure Determination - statistics & numerical data
Chi-Square Distribution
Coronary Artery Bypass - methods
Coronary Disease - physiopathology
Coronary Disease - surgery
Female
Hand - blood supply
Humans
Laser-Doppler Flowmetry - instrumentation
Laser-Doppler Flowmetry - methods
Laser-Doppler Flowmetry - statistics & numerical data
Male
Middle Aged
Radial Artery - physiology
Radial Artery - transplantation
Regional Blood Flow
Reproducibility of Results
ROC Curve
Skin Temperature
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Summary:Objective: Radial artery harvesting for coronary artery bypass may lead to digit ischemia if collateral hand circulation is inadequate. The modified Allen's test is the most common preoperative screening test used. Unfortunately, this test has high false-positive and false-negative rates. The purpose of this study was to compare the results of a modified Allen's test with digit pressure change during radial artery compression for assessing collateral circulation before radial artery harvest. Methods: One hundred twenty-nine consecutive patients were studied before coronary artery bypass operations. A modified Allen's test was performed with Doppler ultrasound to assess blood flow in the superficial palmar arch before and during radial artery compression. A decreased audible Doppler signal after radial artery compression was considered a positive modified Allen's test. First and second digit pressures were measured before and during radial artery compression. A decrease in digit pressure of 40 mm Hg or more (digit ΔP) with radial artery compression was considered positive. Results: Seven of 14 dominant extremities (50%) and 8 of the 16 nondominant extremities (50%) with a positive modified Allen's test had a digit ΔP of less than 40 mm Hg (false positive). Sixteen of 115 dominant extremities (14%) and 5 of 112 nondominant extremities (4%) with a negative Allen's test had a digit ΔP of 40 mm Hg or more with radial artery compression (false negative). Conclusion: Use of the modified Allen's test for screening before radial artery harvest may unnecessarily exclude some patients from use of this conduit and may also place a number of patients at risk for digit ischemia from such harvest. Direct digit pressure measurement is a simple, objective method that may more precisely select patients for radial artery harvest. Additional studies are needed to define objective digital pressure criteria that will accurately predict patients at risk for hand ischemia after radial harvest. (J Thorac Cardiovasc Surg 1999;117:261-6)
ISSN:0022-5223
1097-685X
DOI:10.1016/S0022-5223(99)70421-6