Association Between Preoperative Palmar Arch Velocity on Duplex Ultrasonography and Ischemic Hand Symptoms After Radial Artery Harvest.

Abstract

Duplex ultrasonography is often used to assess radial artery suitability for coronary artery bypass grafting, but clear guidelines for its usage are lacking. This study investigates the association between preoperative arterial velocity characteristics and postoperative ischemic hand symptoms after endoscopic radial artery harvest. We performed a retrospective review of 584 patients who underwent coronary artery bypass grafting with a radial artery graft from 2016 to 2023. Using preoperative duplex ultrasonography, patients were categorized based on their palmar arch reversal velocity during radial artery occlusion: normal (>20 cm/s), marginal (10-20 cm/s), or low (<10 cm/s). The primary outcome was any report of ischemic hand symptoms (pain, weakness, or sensation loss) at the 30-day postoperative follow-up. Of the 584 patients, 421 (72.1%) had normal flow, 139 (23.8%) had marginal flow, and 24 (4.1%) had low flow. The overall incidence of ischemic hand symptoms at 30 days was low at 5.8% (34 patients). There was no significant association between preoperative palmar arch reversal velocity and postoperative symptoms (odds ratio, 1.56 for combined marginal/low flow vs normal; 95% CI, 0.84-2.85). No ischemic events requiring intervention occurred. On multivariable analysis, only diabetes was associated with an increased risk of symptoms (odds ratio, 1.98; 95% CI, 1.11-3.59). Low palmar arch reversal velocity on preoperative duplex ultrasonography was not associated with an increased risk of hand ischemia after radial artery harvest. These findings suggest that harvesting the radial artery is safe in patients with marginal or even low flow, provided ulnar collateral circulation is adequate.