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eComment: Radial artery doppler study in every case?

Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, 119074 Singapore

Non-harvestable radial artery. A bilateral problem?

We were reading the study performed by Kohonen et al. [1] with great interest and congratulate the authors for the additional research on radial arteries. The results give us some hints to predict radial artery availability for total arterial revascularization (TAR) once one side is not suitable.

But we want to raise the question: why not perform Doppler in every case, in spite of negative Allen test, for the case that the radial artery is small in caliber and would not be recommendable? Additionally, the Allen test has to be shown to be not always reliable for the assessment of collateral blood supply [2]. First, all patients should have a Doppler study done.

Second, in Caucasian populations elderly patients should be included since they are subject to controversy as to the age limit to perform TAR because of concerns about higher complication rates due to longer operation times, greater invasiveness of the procedure and the limited live expectancy of the cohort [3].

Some centers provide the opportunity for SV Doppler, which is equally crucial [4]. It has been shown that the diameter ratio (or discrepancy) of the graft vs. coronary target affects the long-term patency rate [5]. A Doppler study in every case should be employed to design the individual graft arrangement.

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1. Kohonen M, Teerenhovi O, Terho T, Laurikka J, Tarkka M. Non-harvestable radial artery. A bilateral problem? Interact CardioVasc Thorac Surg 2008;7:797–800.[Abstract/Free Full Text]
2. Agrifoglio M, Dainese L, Pasotti S, Galanti A, Cannata A, Roberto M, Parolari A, Biglioli P. Preoperative assessment of the radial artery for coronary artery bypass grafting: is the clinical Allen test adequate? Ann Thorac Surg 2005;79:570–572.[Abstract/Free Full Text]
3. Paolini G, Mariani MA, Benussi S, Zuccari M, Di Credico G, Gallorini C, Grossi A. Total arterial myocardial revascularization. Eur J Cardiothorac Surg 1993;7:91–95.[Abstract]
4. Luckraz H, Lowe J, Pugh N, Azzu AA. Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity. Interact CardioVasc Thorac Surg 2008;7:188–191; Discussion 191.[Abstract/Free Full Text]
5. Maniar HS, Sundt TM, Barner HB, Prasad SM, Peterson L, Absi T, Moustakidis P. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovasc Surg 2002;123:45–52.[Abstract/Free Full Text]

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