Abstract
Objective: This study aimed to evaluate the bilateral forehand circulation using a 64-channel
multidetector computed tomography (MDCT) as a noninvasive method to define criteria
for an upper extremity arterial anatomy and pathology prior to the use of arterial
conduits. Materials and Methods: Fifty-five patients with coronary artery disease who underwent total arterial coronary
artery bypass grafting (CABG) were randomly selected for this prospective study. MDCT
angiography was performed for 110 examinations of forearm and hand arterial anatomy.
Prior to MDCT, Allen tests were performed in all patients with a normal result, except
four. Thirteen patients had diabetes mellitus (DM), 8 had peripheral artery occlusive
disease, and 19 had a history of smoking. Results: All arteries, including axillary, ulnar artery (UA) and radial artery (RA), were
clearly visualized in all patients. Upper extremity anatomical and pathological results
were examined in 16 patients (29.1%). Severely calcified RA and/or UA were found in
6 patients who had a moderate renal failure. Nearly total occlusion of the RA was
detected in another two patients. Focal intimal RA calcification was recorded in 1
female and 3 male patients. Ten patients who had severe calcification or intimal sclerosis
of the upper extremity arteries had DM. The remaining patients had normal forehand
arterial circulation. A persistent median artery with the absence of radial and ulnar
arteries and a high bifurcation of RA from the brachial artery was detected as an
anatomic variation in seven patients (12.7%). Conclusions: The major advantages of MDCT angiography are its non-invasiveness and the ability
to detect calcific subadventitial plaques, which are difficult to diagnose using conventional
angiography. MDCT may be used as a safe and non-invasive method to assess RA and UA
prior to harvesting the upper limb artery. Preoperative imaging of forehand arteries
is a means to avoid unnecessary forearm exploration or the use of an unsuitable arterial
conduit in CABG operations, especially in patients with DM and moderate renal impairment.
Keywords
Duplex ultrasonography - hand circulation - multislice computed tomography angiography