Ann Thorac Surg 2004;77:2075
© 2004 The Society of Thoracic Surgeons
Invited commentary
Keith B. Allen, MD
Cardiovascular and Thoracic Surgery, The Heart Center of Indiana, Department of Cardiothoracic Surgery, 10590 N Meridian St, Suite 105, Indianapolis, IN 46290, USA
e-mail: kallen2340{at}aol.com
Considering the emphasis on arterial grafting, the radial artery is increasingly utilized during coronary artery bypass surgery and for many surgeons it is the conduit of choice following the mammary artery. While radial artery harvest complications are rare, the lingering concern that hand ischemia may develop postoperatively may impede its broader adoption. A better understanding of radial artery harvesting and its effect on digital perfusion may increase our "comfort zone" with this conduit.
Lee and colleagues utilized pulse volume recording (PVR) plethysmography to semi-quantitatively measure digital blood flow seven days following radial artery harvesting in 24 patients. Although preoperative PVR's were not obtained, pulse morphology and amplitude were similar between dominant and non-dominant arms in 10 volunteers suggesting that the non-operated arms could be used as controls. While no patients showed evidence of digital ischemia seven days following radial artery harvesting, there was an approximate 50% decrease in blood flow to the operated hand compared to the non-operated hand at rest. Interestingly, despite the absence of the radial artery, there was a redistribution of blood flow preferentially favoring the first two digits over the fourth and fifth digits of the hand. Of note, Lee and colleagues confirmed the reliability of the modified Allen's test using pulse oximetry as a simple, inexpensive test to determine whether the radial artery can be safely harvested.
Several questions remain unanswered. Following radial artery harvest, can evidence of exercise induced hand ischemia be demonstrated using plethysmography or does the ulnar artery adequately compensate over time? The working young whom we often associate radial artery use in, may in fact be at greatest risk for developing arm claudication when they return to vigorous employment. Lee and colleagues provide a stepping stone for further work that will allow us to ensure our patients that harvesting the radial artery is not only good for their heart but that it doesn't hurt the hand that feeds them.
