J R Sadaba, C M Munsch, A Parkin, M Burniston, J Maughen, J L Conroy

Yorkshire Heart Centre, Leeds General Infirmary, Leeds LS1 3EX

Objective: In the present study we attempt to determine the adequacy of tissue perfusion of the hand and forearm following harvesting of the radial artery for coronary artery bypass grafting.

Methods: 1.Twenty patients who had had the radial artery used as one of the grafts for myocardial revascularization underwent bilateral blood flow assessment of hands and forearms using technetium-99m serum albumin. These technique has been said to have the advantage over other methods in that it gives an absolute measurement of flow per unit of volume. 2.Clinical evaluation, including grip and pinch strengh tests, forearm exercise test and subjective assessment of hand function was performed in all patients.

Results: 1. Mean tissue perfusion in ml/100ml/min ( standard deviation were as follows: donor hand 21.9(5.6, non-donor hand 25.5(6.1, donor forearm 17.5(3.7 and non-donor forearm 21(5.1. There was a statistically significant difference in the tissue perfusion between the donor and non-donor side hands (p=0.00043) and forearms (p=0.000681). No clinical evidence of hand claudication was detected.

Conclusion: Unlike previous reports, this study suggests that removal of the radial artery significantly reduces the tissue perfusion of the hand and forearm. Although we have failed to prove any clinical deficit in hand function in the short term, these findings deserve consideration. We feel that, in the abscense of long-term follow-up reports, the decision to use the radial artery as a graft in patients at risk of developing peripheral vascular disease should be carefully weighed.