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Radial artery compression in incomplete palmar arch for radial artery harvesting
Prashant N Mohite1, Shyam K Thingnam, Akshay K Saxena
1Department of Cardiothoracic and Vascular Surgery, Post-Graduation Institute of Medical Research and Education, Chandigarh, India.
Background:
incomplete palmar arch causing inadequate collateral flow is considered a contraindication for harvesting radial artery as a conduit for coronary artery bypass grafting. The objective of this pilot study was to assess whether iatrogenic radial artery compression could improve collateral circulation in the nondominant hand in such patients.
Methods:
5 patients scheduled for coronary artery bypass, with incomplete palmar arch suspected by an abnormal modified Allen's test and confirmed by dynamic color Doppler sonography, were included in the study. The flow in branches of the radial artery (superficial palmar branch and dorsal digital artery of the thumb) was measured by dynamic color Doppler sonography. Intermittent radial artery compression was applied to the nondominant hand, using a radial compression device for 15 days, and the tests were repeated to assess changes in radial artery branch flow.
Results:
flow in the superficial palmar branch was increased in 3 patients, with a significant increase in 2 of them. The 3 patients in whom the dorsal digital artery of the thumb could be seen on precompression Doppler, all had substantially increased flow. The increase in flow assessed by the modified Allen's test was statistically significant, but the flow change measured by Doppler sonography did not reach statistical significance.
Conclusions:
collaterals developed during 15 days of intermittent radial artery compression. The collateral development led to increased flow in the radial artery branches. A larger sample is required to confirm the results.
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