Related Experiment Video
Updated: Jul 2, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Radial artery harvesting for coronary artery bypass grafting: a stepwise-made decision
Petar M Vuković1, Sandra S Radak, Miodrag S Perić
1Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia. petarvuk@eunet.yu
Insights
A new testing system safely selects radial arteries for bypass surgery. Preoperative assessments identified 30.1% of patients as unsuitable for radial artery harvesting due to morphology or poor collateral circulation.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Diagnostic Imaging
Background:
- Radial artery harvesting is crucial for coronary artery bypass grafting.
- Selecting suitable radial arteries requires careful evaluation of morphology and collateral circulation.
- Standardized preoperative assessment protocols are needed to ensure graft patency and patient safety.
Purpose of the Study:
- To propose a safe, stepwise testing system for selecting suitable radial arteries for use as conduits.
- To evaluate the morphology and collateral circulation characteristics of radial arteries.
- To establish criteria for excluding radial arteries based on anatomical and functional properties.
Main Methods:
- 113 patients underwent modified Allen test, Doppler ultrasonography, and pulse oximetry before surgery.
- Morphologic criteria for exclusion included small artery diameter (<2mm), calcifications, and anomalies.
- Insufficient collateral circulation was defined by absent snuffbox flow or <20% ulnar flow velocity increase.
Main Results:
- Modified Allen test was positive in 10.6% of patients.
- Doppler ultrasonography excluded 23.9% of patients due to vascular abnormalities.
- Pulse oximetry was abnormal in 6.2% of patients, with 30.1% ultimately deemed unsuitable for harvesting.
Conclusions:
- Preoperative testing (modified Allen, Doppler, pulse oximetry) effectively identifies unsuitable radial arteries.
- The proposed system allows for radial artery selection based on morphology, collateral capacity, and ulnar artery properties.
- This approach enhances the safety and efficacy of radial artery utilization in bypass procedures.
Background:
The purpose of this study was to propose a safe, stepwise, testing system to select radial arteries that are suitable for conduits on the basis of their morphologies and characteristics of the collateral circulation.
Methods:
Before operation, 113 patients underwent the modified Allen test, Doppler ultrasonography, and pulse oximetry testing. Morphologic criteria used for radial artery exclusion were small size of radial or ulnar artery (< 2 mm in inner diameter), diffuse calcifications, and congenital anomalies of forearm arteries. Collateral circulation was interpreted as insufficient if the reverse flow in the anatomic snuffbox was absent or if the increase of the ulnar peak systolic flow velocity was less than 20%.
Results:
A positive modified Allen test was found in 10.6% of patients. As assessed by Doppler ultrasonography, 27 patients (23.9%) were not candidates for radial artery harvesting according to morphologic and functional abnormalities of forearm and hand circulation. Pulse oximetry test results were abnormal in 6.2%. After a follow-up period of 8.9 +/- 1.8 months, 23 patients (29.1% of operated patients) were controlled for Doppler ultrasonographic changes in the ulnar artery. The mean peak systolic flow velocity was significantly higher than the preoperative value measured at rest (p < 0 .001).
Conclusions:
After preoperative tests, including the modified Allen test, Doppler ultrasonography, and pulse oximetry, 30.1% of patients were not considered candidates for radial artery harvesting. This method provides preoperative radial artery selection according to its morphologies, compensatory capacity of collateral circulation, and anatomic properties of ulnar artery.
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:12Arteries of the Upper Limbs
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation