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The snuffbox technique: a reliable color Doppler method to assess hand circulation.
Kazuhiro Kochi1, Kazumasa Orihashi, Taijiro Sueda
1First Department of Surgery, Hiroshima University, School of Medicine, Hiroshima, Japan. userdrkk@aol.com
The Journal of Thoracic and Cardiovascular Surgery
|April 17, 2003
Summary
The new snuffbox technique using color Doppler precisely assesses hand circulation before radial artery harvesting. This objective method reliably predicts blood flow, improving patient safety.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Cardiovascular Physiology
Background:
- The traditional Allen test for assessing hand circulation before radial artery harvesting is subjective and lacks objectivity.
- Existing color Doppler methods often neglect optimal insonation angles (<30 degrees) and lack rigorous comparison with established standards.
- There is a need for an objective, reliable color Doppler method to evaluate hand perfusion prior to radial artery harvesting.
Purpose of the Study:
- To introduce and evaluate the 'snuffbox technique' using color Doppler for assessing radial artery patency.
- To compare the efficacy of the snuffbox technique against stump pressure, a criterion standard, in evaluating hand circulation.
- To determine if color Doppler measurements in the snuffbox area can reliably predict blood flow post-radial artery harvesting.
Main Methods:
- Maximal flow velocity and Doppler angles were measured in the snuffbox, palmar, and ulnar arteries in 20 hands.
- Measurements were taken before and after radial artery harvesting, with stump pressure recorded during surgery.
- The snuffbox technique involved measuring the radial artery at its most distal point after harvesting, adhering to Doppler principles (<30 degrees).
Main Results:
- The snuffbox technique demonstrated decreased maximal flow velocity with radial artery compression and after harvesting, showing simultaneous flow reversal.
- Ulnar artery flow velocity increased post-compression and harvesting, while palmar artery flow remained unchanged.
- Doppler angles in the snuffbox were optimal (20.9° ± 6.0°), and changes correlated highly with stump pressure ratio (P < .001).
Conclusions:
- The snuffbox technique using color Doppler is a precise and reliable method for assessing hand circulation.
- This objective technique provides a significant improvement over the subjective Allen test for pre-operative evaluation.
- The snuffbox technique accurately reflects hand perfusion status, crucial for safe radial artery harvesting.