Original articleCardiovascularNo Late Ulnar Artery Atheroma After Radial Artery Harvest for Coronary Artery Bypass Surgery
Section snippets
Patients and Methods
Patients with unilateral radial artery harvest at least seven years before were identified from the investigating surgeon’s database as a single surgeon and single institution experience. During this time, radial artery use by the surgeon was in more than 95% of patients and for the institution, more than 80% [2]. Before harvesting, the Allen test was used and there were no episodes of hand ischemia after harvest. The University of Melbourne Human Research Ethics Committee approved the study
Results
Eighty five patients were assessed, 71 males, at an age 70.6 ± 8.8 years (range, 43 to 88). The time after surgery was 8.4 ± 1.0 years (range, 7.2 to 11.1). Demographic data are presented in Table 1. The data for body mass index and body surface area approximated the normal distribution. Of note, 32% of patients were considered obese (body mass index >30). Previous smokers represented 55% of patients, and ongoing current smokers 12%.
No atheromatous plaques were detected in the ulnar or radial
Comment
This study examined 85 patients at 7 to 11 years after unilateral radial artery harvest for coronary artery bypass surgery. We found no atheroma in the ulnar arteries of these patients, either on the side where the radial artery had been harvested or on the side where the radial artery had not been harvested. This important finding confirms late freedom from accelerated atherosclerosis involving the remaining ulnar artery when the radial artery was used as a coronary artery bypass graft.
After
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Cited by (13)
Pediatric Replantation and Revascularization
2019, Hand ClinicsCitation Excerpt :Long term, the ulnar artery lumen enlarges to accommodate greater flow after radial artery harvesting. Although some have suggested that this enlargement would predispose to early vascular disease, recent evidence refutes this supposition.41 The long-term consequences of ulnar artery harvest/ligation are less clear.
Does Radial Artery Harvest for Coronary Surgery Compromise Forearm Blood Flow to 22 Years Post-Operative?
2018, Journal of the American College of CardiologyInvestigation of Ultrasound-Measured Flow Velocity, Flow Rate and Wall Shear Rate in Radial and Ulnar Arteries Using Simulation
2017, Ultrasound in Medicine and BiologyCitation Excerpt :For instance, the WSR or its derivative, wall shear stress, has been used in the remodeling of the radial artery after arteriovenous fistula for hemodialysis access in many studies (Manini et al. 2014; Remuzzi et al. 2003). Furthermore, in radial artery harvesting for coronary bypass surgery, pre-operative assessment of the adequacy of the collateral ulnar circulation to the hand by detecting the FV or FR in the ulnar artery is necessary to avoid postoperative ischemia, which could lead to severe risk (Habib et al. 2012; Royse et al. 2008). The FV and its related parameter FR also have chosen to help distinguish different types of Raynaud's syndrome.
Investigation of Ultrasound-Measured Flow Rate and Wall Shear Rate in Wrist Arteries Using Flow Phantoms
2016, Ultrasound in Medicine and BiologyCitation Excerpt :Before catheterization, ultrasound imaging is often used to determine the blood flow rate in the ulnar artery to ensure that the collateral circulation via the ulnar artery is adequate to perfuse the hand (Habib et al. 2012). Measurement of the volumetric flow rate and resistive index of flow waveforms in the ulnar artery is also required in cannulation of the radial artery and radial harvesting for coronary surgery (Gaudino et al. 2005; Kim et al. 2012; Royse et al. 2008). Blood flow velocities and waveforms in the radial and ulnar arteries have been used to evaluate the sympathetic skin response of poststroke patients as compared with healthy subjects (Tiftik et al. 2014).
Complications related to radial artery occlusion, radial artery harvest, and arterial lines
2015, Hand ClinicsCitation Excerpt :The same investigators reported that the digital blood flow eventually improves as a result of increased flow through the ulnar artery.25 Other studies have reported no increased incidence of atherosclerotic plaques in the ulnar artery at late follow-up, but with increased peak systolic velocity in the ulnar artery long-term sequelae are still unknown.26,27 Hence the late hand and forearm morbidity following radial artery harvest may also depend on the overall health and comorbidities of the individual patient.
Absence of deterioration of vascular function of the donor limb at late follow-up after radial artery harvesting
2011, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Their inference was in favor of potential impairment of blood flow to the hand and forearm due to accelerated atherosclerosis. A second report of 85 patients at a mean follow-up of 8.4 years after RA harvest found no new atheroma and increases in both UA diameter and flow relative to control values (111 mL/min vs 59 mL/min, P < .001).2 Both these studies were exclusively based on Doppler ultrasonographic imaging to assess flow characteristics, artery diameters, and wall structure.