Predictive Value of Intraoperative In Situ Radial Artery Conduit Flow Assessment Prior to Harvesting during Coronary Artery Bypass Surgery

Abstract

Objective: Radial artery (RA) is increasingly preferred as the second best conduit in coronary artery bypass grafting (CABG). Harvesting techniques affect the integrity of the RA with implications for the immediate and late outcome. The aim of this study was to describe a simple intra-operative technique that allows the quality of the RA to be assessed prior to its harvesting during CABG. Methods: The study group consisted of 54 patients who underwent CABG. A 2-cm vertical incision was made over the nondominant RA pulse. A limited pedicle of the RA was positioned inside the metal cradle of the flexible flow probe. Baseline transit-time ultrasonic flow and pulsatility index (PI) were measured. Results: Average in situ RA flow was 18.6 ml/min (range 4–51 ml/min). Of 14 in situ RAs, all but three RAs were found to have adequate flow characteristics and were used as conduits. In the three unsuitable RAs, one had complete obliteration and no flow; one had visible calcifications and very low flow and the third one had a weak pulse, low flow and high PI. Conclusion: Routine assessment of in situ RA flow characteristics via a 2-cm incision provides useful information about RA conduit quality prior to its formal harvesting during CABG. Despite considerable skepticism about the use of the radial artery due to its vasospastic potential, this technique may increase utilization rates of the RA as a conduit during CABG, in particular in many young diabetic patients.

Key words

coronary bypass surgery - radial artery - flow assessment - radial artery

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