HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anil Bhan Richard F. Brodman Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bhan, A. Articles by Frame, R. Search for Related Content PubMed PubMed Citation Articles by Bhan, A. Articles by Frame, R.

Ann Thorac Surg 1996;62:1572-1573
© 1996 The Society of Thoracic Surgeons

---

Correspondence

Extended Use of Pulse Oximetry in Harvesting Radial Artery

Department of Cardiothoracic Vascular Surgery All India Institute of Medical Sciences Ansari Nagar, New Delhi, 110 029 India

To the Editor:

After its introduction in 1970, the enthusiasm for the radial artery as a bypass conduit was lost because of poor short-term patency rates. However recently Acar and associates [1] have revived the use of this conduit. The important decision of harvesting the radial artery depends heavily on Allen's test.

Use of pulse oximetry for this purpose has been recommended by Reyes and associates [2]. It gives an idea about oxygen saturation before and after temporary clipping of the radial artery. We believe that the magnitude of the pulse wave form would be a more reliable indicator than the numeric saturation value. In 1 patient, although the pulse oximeter showed satisfactory saturation values, the magnitude of the wave form become significantly small and we abandoned the procedure with the apprehension of producing significant ischemia.

References

1. Acar C, Jebara VA, Portoghese M, et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992;54:652–60.[Abstract]
2. Reyes AT, Frame R, Brodman RF. Technique for harvesting the radial artery as a coronary artery bypass graft. Ann Thorac Surg 1995;59:118–26.[Abstract/Free Full Text]

Reply

Department of Cardiothoracic Surgery Montefiore Medical Center The Albert Einstein College of Medicine 111 E 210 St Bronx, NY 10467

To the Editor:

In response to Bhan and colleagues' comments regarding our use of pulse oximetry during radial artery harvest, we did not and do not use oxygen saturation as a means of assessing adequacy of perfusion. Oxygen saturation is not a sensitive indicator of perfusion. Oxygen saturation drops below normal after perfusion is already inadequate. We did not mean to imply that we used it as a method of intraoperative assessment. In fact, we no longer use digital oxygen saturation for intraoperative monitoring during radial artery harvest because false positives occur for a variety of reasons.

Our approach for assessing adequacy of collateral forearm circulation from the beginning of our experience with radial artery harvest has been to make this judgement by preoperative assessment and do no further testing in the operating room. We may not have made this entirely clear in our publication, although we did state "...when preoperative assessment confirms adequate collateral supply to the radial aspect of the hand, use of the [radial artery] is an excellent and attractive adjunct" [1].

Doctor Bhan and colleagues' observation in 1 case that the pulse oximeter wave form became significantly smaller with a "satisfactory saturation" value is of some interest, but "satisfactory value" is not defined. They also did not provide us with the type of oximeter used; therefore, it is not clear whether they are using a device with or without automatic gain control of the wave form. Looking at a wave form on the oximeter screen does not provide the resolution necessary to make a decision on a quantitative change in value.

The positive predictive accuracy of Allen's test is low, and it is a subjective test and requires patient cooperation. If one is willing to accept a not infrequently false positive Allen's test and exclude those patients as candidates for radial artery harvest, then Allen's test is a satisfactory, though not ideal, gross screening tool. If the result is somewhat inconclusive, it is better not to harvest if one is relying solely on Allen's test as the negative predictive accuracy is not 100%.

Reference

1. Reyes AT, Frame R, Brodman RF. Technique for harvesting the radial artery as a coronary artery bypass graft. Ann Thorac Surg 1995;59:118–26.

This article has been cited by other articles:

				H.-S. Lee, Y. J. Heo, and B.-C. Chang Long-term digital blood flow after radial artery harvesting for coronary artery bypass grafting Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 99 - 103. [Abstract] [Full Text] [PDF]

				H.-S. Lee, B.-C. Chang, and Y. J. Heo Digital blood flow after radial artery harvest for coronary artery bypass grafting Ann. Thorac. Surg., June 1, 2004; 77(6): 2071 - 2074. [Abstract] [Full Text] [PDF]

				A. Bhan, V. Gupta, S. K. Choudhary, R. Sharma, B. Singh, R. Aggarwal, B. Bhargava, A. V. Sharma, and P. Venugopal Radial artery in CABG: could the early results be comparable to internal mammary artery graft? Ann. Thorac. Surg., June 1, 1999; 67(6): 1631 - 1636. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anil Bhan Richard F. Brodman Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bhan, A. Articles by Frame, R. Search for Related Content PubMed PubMed Citation Articles by Bhan, A. Articles by Frame, R.