Upper extremity hemodynamic changes after
radial artery harvest for coronary artery bypass grafting.
The reasons for failure of trans-radial procedure included failed
radial artery puncture (n=2),
radial artery loop and tortuous subclavian artery (N=5), failed catheterization of coronary arteries (N=4) and severe
radial artery spasm (N=15).
It is important to perform angiography as it is possible that sometimes pain may not be due to spasm but other reasons such as coiling or looping in radial, sub-clavian or brachial arteries which provide difficulty in moving catheter and cause torment to the patients.1
Radial artery spasm occurs due to small diameter of artery, diabetes, old age, females, lower BMI, and first attempt failure in cannula placement.
Besides, it might not be always possible to design the bone as a smaller anatomical structure and elevate it with technical vascularized bone grafts from the palmar carpal artery arising from the
radial artery for repairing nonunion or malunion of scaphoid bones.
The NIBP recorded by cuff method and IAP noted from the monitor when the catheter is in situ at
radial artery and aorta.
Finally, successful balloon puncture is only feasible with a pointed and cut 23 gauge syringe needle and does not leave any damage to the
radial artery wall.
The procedure could not be completed in 28 patients mainly because of tortuosity or calcification of the subclavian artery in 19 patients (14 in right radial approach and five in left radial approach group, p=0.015) and for reasons related to the
radial artery in nine patients (four in right radial approach and 5 in left radial approach group, p=0.92).
In our patient, we excised the aneurysmal sac and ligated the
radial artery due to the positive Allen's test that confirmed the ulnar artery dominancy and findings of intraoperative Doppler ultrasound.
Conclusion: Ultrasound guided
radial artery cannulation is associated with higher rate of successful insertion and less time is required for arterial line insertion as compared to blind palpation method.
After the insertion of 5 Fr sheaths into his right
radial artery, a Boston Scientific 5 Fr FL 3.5 catheter was inserted into his left coronary artery.
The efficiency of collateral circulation in hand is essential in few peripheral vascular diseases like Raynaud's disease and harvesting of the
radial artery for the coronary bypass graft.