Analysis of digital pulse-volume recordings with radial and ulnar artery compression.

The vascular noninvasive studies of 289 consecutive cardiac surgery patients were reviewed to better understand hand blood-flow physiology in an older population with vascular disease. The radial artery was found to be more important to pulsatile digital blood flow than the ulnar artery. In more than 20 percent of hands, the thumb and the index and fifth fingers lost pulsatile blood flow with radial artery compression at the wrist compared with only 5 percent with ulnar artery compression. The maintenance of pulsatile digital blood flow did not follow anatomic patterns of blood vessels previously presumed to be of paramount importance. The hand acts more like a single vascular bed than it does like two separate systems with a connecting arch.

Long-term recovery following surgical treatment for ulnar artery occlusion.

Fourteen patients were surgically treated for ulnar artery occlusion. Digital blood pressure measurements obtained pre- and intraoperatively helped guide the choice between ligation or reconstruction of the ulnar artery following resection of the occluded segment. The digital brachial index (DBI) was derived by calculating the ratio of digital blood pressure to the simultaneous brachial artery pressure. A DBI value of less than or equal to 0.7 was an indication for arterial reconstruction. If the DBI was greater than 0.7, resection of the occluded arterial segment without reconstruction was considered appropriate. Eight patients were treated by arterial reconstruction and six patients were treated with arterial resection. Seven of the eight reconstructed ulnar arteries were patent at follow-up evaluation by Doppler evaluation. DBI measurements obtained at follow-up were compared to preoperative values. In the reconstruction group, DBI change in the small, ring, and index fingers was positive, whereas it was negative in the resection group. Eleven patients indicated improvement from their presurgical status, although over half continued to experience pain on a regular basis. Reports of environmental and contact cold intolerance also showed improvement following surgery. Complaints of pain and cold intolerance were not significantly different between the resection and reconstruction groups at follow-up evaluation.

The examination in the vascular laboratory.

Using the examination of any body system, and examiner must be able to detect and assess disease as accurately as possible and then evaluate the status of the remaining function. When studying the vascular system of the upper extremity in particular, physiologic information must be provided in addition to the more commonly investigated structural information. The circulatory system fluctuates to meet the stresses of everyday life. Critical functional data can be provided by a knowledgeable technician in a vascular laboratory with a variety of noninvasive techniques and testing approaches. Not only can the presence and location of vascular disease be determined, but also the subsequent medical or surgical treatment can be facilitated. Even more important, standardized testing protocols can be adapted to fit the individual needs of a patient.