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Bifurcating radial artery
IMAGES IN CARDIOTHORACIC SURGERY
Bifurcating Radial Artery Martin H. Chamberlain, FRCS, and David P. Taggart, PhD Oxford Heart Institute, John Radcliffe Hospital, Oxford, United Kingdom
A
69-year-old man was admitted for elective coronary artery bypass surgery. Prior to surgery, the operating surgeon assessed the arterial circulation to the left hand. Both ulnar and radial pulses were present, and the Allen’s test was normal. At operation, the left radial artery was skeletonized to gain extra conduit length. It was found to bifurcate 5 cm proximal to the styloid process of the radius (Fig 1). The two branches ran parallel, together and under the flexor retinaculum. The decision was made to remove the radial artery and sacrifice one of the branches. The left internal mammary artery was anastamosed to the left anterior descending coronary artery, and the radial artery was anastamosed to the intermediate coronary artery. No other coronaries were suitable for grafting. The patient made an uneventful recovery with no adverse affects noted in the left forearm. Many cardiac surgeons now favor total arterial revascularization, and the radial artery is their preferred conduit along with the internal mammary arteries. Our case illustrates the need to carefully assess patients preoperatively, and to have a detailed knowledge of the
Address reprint requests to Dr Taggart, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK; e-mail: [email protected].
© 2001 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Fig 1.
anatomical variations of the arterial supply of the upper limb, before attempting to harvest the radial artery. Advantage could have been made of this anomaly by constructing a Y-graft with the radial artery, had the coronary anatomy allowed. Duplex scanning may have identified this abnormality preoperatively but is not routine practice in our unit.
Ann Thorac Surg 2001;72:1399 • 0003-4975/01/$20.00 PII S0003-4975(00)02602-3
Bifurcating Radial Artery Martin H. Chamberlain, FRCS, and David P. Taggart, PhD Oxford Heart Institute, John Radcliffe Hospital, Oxford, United Kingdom
A
69-year-old man was admitted for elective coronary artery bypass surgery. Prior to surgery, the operating surgeon assessed the arterial circulation to the left hand. Both ulnar and radial pulses were present, and the Allen’s test was normal. At operation, the left radial artery was skeletonized to gain extra conduit length. It was found to bifurcate 5 cm proximal to the styloid process of the radius (Fig 1). The two branches ran parallel, together and under the flexor retinaculum. The decision was made to remove the radial artery and sacrifice one of the branches. The left internal mammary artery was anastamosed to the left anterior descending coronary artery, and the radial artery was anastamosed to the intermediate coronary artery. No other coronaries were suitable for grafting. The patient made an uneventful recovery with no adverse affects noted in the left forearm. Many cardiac surgeons now favor total arterial revascularization, and the radial artery is their preferred conduit along with the internal mammary arteries. Our case illustrates the need to carefully assess patients preoperatively, and to have a detailed knowledge of the
Address reprint requests to Dr Taggart, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK; e-mail: [email protected].
© 2001 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Fig 1.
anatomical variations of the arterial supply of the upper limb, before attempting to harvest the radial artery. Advantage could have been made of this anomaly by constructing a Y-graft with the radial artery, had the coronary anatomy allowed. Duplex scanning may have identified this abnormality preoperatively but is not routine practice in our unit.
Ann Thorac Surg 2001;72:1399 • 0003-4975/01/$20.00 PII S0003-4975(00)02602-3