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Nappi F, Bellomo F, Nappi P, Chello C, Iervolino A, Chello M, Acar C. The Use of Radial Artery for CABG: An Update. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5528006. [PMID: 33928147 PMCID: PMC8049807 DOI: 10.1155/2021/5528006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Francesca Bellomo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Camilla Chello
- Regenerative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Adelaide Iervolino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Italy
| | - Massimo Chello
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Christophe Acar
- Department of Cardiac Surgery, La Pitié Salpetriere Hospital, Paris, France
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van Leeuwen MAH, Hollander MR, van der Heijden DJ, van de Ven PM, Opmeer KHM, Taverne YJHJ, Ritt MJPF, Kiemeneij F, van Mieghem NM, van Royen N. The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access): A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005753. [PMID: 29127118 DOI: 10.1161/circinterventions.117.005753] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown. METHODS AND RESULTS The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77). CONCLUSIONS Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization.
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Affiliation(s)
- Maarten A H van Leeuwen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Maurits R Hollander
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Peter M van de Ven
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Kim H M Opmeer
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Yannick J H J Taverne
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Marco J P F Ritt
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Ferdinand Kiemeneij
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Nicolas M van Mieghem
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Niels van Royen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.).
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Blake DF, Young DA, Brown LH. Transcutaneous oximetry: variability in normal values for the upper and lower limb. Diving Hyperb Med 2018; 48:2-9. [PMID: 29557095 DOI: 10.28920/dhm48.1.2-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/07/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Published normal transcutaneous oxygen partial pressures (PtcO2) for the chest and lower limb have defined tissue hypoxia as a value of < 40 mmHg (< 30 mmHg in some patients, < 50 mmHg in others). AIM To determine 'normal' PtcO2 for the upper and lower limb in healthy, non-smoking adults using the Radiometer® TCM400 with tc Sensor E5250. METHOD Thirty-two volunteers had transcutaneous oxygen measurements (TCOM) performed on the chest, upper and lower limbs breathing air, with leg then arm elevated and whilst breathing 100% oxygen. RESULTS Room-air PtcO2 (mmHg, mean (95% confidence interval)) were: chest: 53.6 (48.7-58.5); upper arm: 60.0 (56.1-64.0); forearm: 52.3 (44.8-55.8); dorsum of hand: 50.2 (46.1-54.3); thenar eminence: 70.8 (67.7-73.8); hypothenar eminence: 77.9 (75.1-80.7); lateral leg: 50.2 (46.2-54.2); lateral malleolus: 50.5 (46.6-54.3); medial malleolus: 48.9 (45.6-52.1); dorsum, between first and second toe: 53.1 (49.2-57.0); dorsum, proximal to fifth toe: 58.5 (55.0 - -62.0); plantar, 1st MTP: 73.7 (70.3-77.1). Nineteen subjects had at least one room-air PtcO2 below 40 mmHg (nine upper limb, 13 lower limb, four chest). Approximately 10% lower limb PtcO2 were < 100 mmHg on normobaric oxygen. Only one subject at one site had an upper limb PtcO2 < 100 mmHg breathing oxygen. CONCLUSION The broad dispersion in PtcO2 in our healthy cohort reflects the inherent biologic variability in dermal perfusion and oxygen delivery, making it difficult to define narrow, rigid 'normal' values. Thus, we cannot recommend a single PtcO2 value as 'normal' for the upper or lower limb. A thorough patient assessment is essential to establish appropriateness for hyperbaric oxygen therapy, with TCOM used as an aid to guide this decision and not as an absolute.
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Affiliation(s)
- Denise F Blake
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.,Marine Biology and Aquaculture, James Cook University, Townsville.,IMB 23, Emergency Department, 100 Angus Smith Drive, The Townsville Hospital, Douglas, Queensland 4814, Australia,
| | - Derelle A Young
- Hyperbaric Medicine Unit, The Townsville Hospital, Townsville
| | - Lawrence H Brown
- Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.,Marine Biology and Aquaculture, James Cook University, Townsville
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