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Duplex scanning to assess radial artery suitability for coronary artery bypass grafting
M Hosono1, S Suehiro, T Shibata
1Second Department of Surgery, Osaka City University Medical School, Japan.
Insights
Duplex ultrasonography reliably assesses radial artery suitability for coronary artery bypass grafting by evaluating anatomy and palmar arch. This noninvasive method identifies suitable arteries and detects issues like atherosclerosis or small diameters.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Cardiovascular Research
Background:
- Coronary artery bypass grafting (CABG) often utilizes the radial artery as a graft.
- Preoperative assessment of radial artery suitability is crucial for successful CABG outcomes.
- Duplex ultrasonography offers a noninvasive method for vascular evaluation.
Purpose of the Study:
- To assess the suitability of the radial artery for CABG using duplex ultrasonography.
- To evaluate radial artery diameter, flow velocity, and palmar arch integrity noninvasively.
Main Methods:
- Duplex ultrasonography was performed on 55 patients to scan the radial artery.
- Internal diameter and mean flow velocity were measured at proximal, medial, and distal sites.
- Flow velocity was assessed before and after radial artery occlusion to evaluate palmar arch function.
Main Results:
- Atherosclerotic changes were noted in 4 patients.
- Radial artery diameter decreased distally (3.1 mm proximally to 2.4 mm distally).
- Palmar arch patency influenced flow dynamics; 15 patients were unsuitable for grafting due to anatomical or vascular limitations.
Conclusions:
- Duplex ultrasonography provides reliable noninvasive assessment of radial artery anatomy.
- Palmar arch continuity can be accurately evaluated using duplex scanning.
- This technique aids in selecting suitable radial arteries for coronary artery bypass grafting.
Objective:
Radial artery suitability in coronary artery bypass grafting was assessed using duplex ultrasonography.
Subjects And Methods:
The vascular condition along the entire radial artery was scanned in 55 patients, measuring the internal diameter and mean flow velocity at the wrist (distally), after ulnar artery branching (proximally), and midway between these 2 points (medially). Distally along the radial and ulnar arteries, the mean flow velocity was determined before and after radial artery occlusion.
Results:
Atherosclerotic changes were detected in 4 patients. The internal diameter was 3.1 +/- 0.4 mm proximally, 2.7 +/- 0.3 mm medially, 2.4 +/- 0.4 mm distally. The distal flow velocity was 0, and a reverse flow (peak velocity: 11.3 +/- 6.0 cm/s) was observed after the occlusion test in patients with an intact palmar arch, their mean flow velocity, 21.1 +/- 8.9 cm/s, and flow distally along the ulnar artery 58.0 +/- 23.4 ml/min, were higher after the occlusion test than before it 14.7 +/- 6.7 cm/s mean flow and 38.1 +/- 15.9 ml/min distally. This was not observed in patients with an interrupted palmar arch. In 15 patients, radial arteries could not be used because of their small internal diameter, lack of a radial artery, poor vascular condition, or an interrupted palmar arch evaluated using duplex scanning.
Conclusion:
Reliable noninvasive assessment of radial artery anatomy and palmar arch continuity is thus possible using duplex ultrasonography.