Subclinical injury to forearm nerves during radial harvesting: electrophysiologic study.

BACKGROUND AND AIM: There are few reports about injury to forearm nerves and its potential mechanisms during radial artery (RA) harvesting. We studied electrophysiologic changes in these nerves not sought until now. METHODS: Among 152 consecutive patients who underwent coronary artery bypass surgery between February 2002 and August 2002, 20 were randomized for RA harvesting and formed the study group and 20 were randomized as control group. Neurologic examination and electrophysiologic studies were performed for sensory and motor impairment of the nerves in both groups pre- and postoperatively. RESULTS: There was no change on neurologic examinations before and after surgery. Electromyography (EMG) revealed significant reduction in sensory and motor conduction amplitudes of median, ulnar, and radial nerves and motor conduction velocities of median and ulnar nerves at the level of forearm in the study group. In the control group, ulnar nerve was mostly affected. When two groups are compared, sensory and motor amplitude drops of median and radial nerves and motor velocity impairment of median nerve in the study group are significant. Ulnar nerve impairments are identical in both groups. CONCLUSIONS: Handling of tissues, minor hematoma or edema along with chest retraction best explains these impairments. Patients were asymptomatic after surgery showing that EMG is highly sensitive and is not predictive of clinical impairment.

[Color Doppler US evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting]. / Radyal arterin greft olarak çikarilmasi öncesi elin renkli Doppler US ile degerlendirilmesi.

PURPOSE: The aim of this study was to evaluate color Doppler ultrasonography in assessing hand collateral circulation before radial artery harvesting for coronary artery bypass grafting. MATERIALS AND METHODS: The hand circulation of 30 patients scheduled for coronary artery bypass grafting was assessed by means of the modified Allen test and Doppler ultrasonography dynamic test. The test was performed by recording the flow in the superficial palmar branch of the radial and ulnar arteries with and without compression of the radial artery. In the postoperative period hemodynamic changes in the ulnar artery were also detected by means of Doppler ultrasonography. RESULTS: Among the 30 patients, one had abnormal and the other 29 had normal Doppler ultrasonography dynamic test results. All the patients' modified Allen test results were also normal. In 14 patients radial artery graft was used in the coronary artery bypass operation. CONCLUSION: Doppler ultrasonography dynamic test is an effective and noninvasive method in the preoperative evaluation of the hand collateral circulation for the safe removal of a radial artery graft.