Work

Low palmar arch velocity does not predict hand dysfunction after radial artery harvest: A prospective analysis of duplex ultrasonography

Year: 2026

Type: article

Abstract: Objectives: Preoperative assessment of radial artery suitability commonly relies on the Allen test, a subjective bedside maneuver. We evaluated whether duplex ultrasonography flow metrics predict postoperative hand function after radial artery harvest for coronary artery bypass grafting. Methods: Patients undergoing elective coronary artery bypass grafting (October 2024 to February 2026) with an appropriate second arterial conduit target underwent preoperative Allen testing and upper-extremity duplex ultrasonography, including palmar arch velocity with radial artery occlusion (PAVRO) and ulnar augmentation (percentage increase in ulnar artery flow with radial occlusion). Hand function (grip and pinch strength, fatigue, and dexterity) and patient-reported symptoms were measured preoperatively and at 1 month. Analysis of covariance and logistic regression models were adjusted for baseline hand function, age, sex, and the presence of diabetes. Results: = .002); no patient with ulnar augmentation >40% had a clinically meaningful (>20%) decrease in grip strength. Allen test results had low concordance with duplex ultrasonography: 11 of 23 patients deemed unsuitable by duplex had a normal Allen test result at the 3-second threshold, and 13 of 47 harvested patients had an abnormal Allen test results. Conclusions: Low PAVRO does not predict hand dysfunction after radial artery harvest, whereas lower ulnar augmentation may better identify patients at risk of grip strength decrease postoperatively. Duplex ultrasonography provides objective flow metric data and should be prioritized in preoperative assessment.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102065