Low palmar arch velocity does not predict hand dysfunction after radial artery harvest: A prospective analysis of duplex ultrasonography.
4 affiliations
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
- 2Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
- 3Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
- 4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa.
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
Thirty-nine patients underwent radial harvest with complete follow-up. Low PAVRO was not associated with postoperative change in any hand function metrics. Increased ulnar augmentation was associated with greater postoperative mean grip strength (P = .017) and fatigue resistance (P = .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.
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BibTeX
@article{szeto2026palmar,
title = {{Low palmar arch velocity does not predict hand dysfunction after radial artery harvest: A prospective analysis of duplex ultrasonography.}},
author = {Jonathan J Szeto and James Lao and Pamela Beniwal and Miranda Song and Waseem Lutfi and Victor Xu and Marisa Konig and Ziwei Pan and Pablo Kurzan and Sankrit Kapoor and Jennifer J Chung and Michael Ibrahim and Wilson Y Szeto and Chase R Brown},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.102065},
url = {https://europepmc.org/article/MED/42948511},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Low palmar arch velocity does not predict hand dysfunction after radial artery harvest: A prospective analysis of duplex ultrasonography.
AU - Jonathan J Szeto
AU - James Lao
AU - Pamela Beniwal
AU - Miranda Song
AU - Waseem Lutfi
AU - Victor Xu
AU - Marisa Konig
AU - Ziwei Pan
AU - Pablo Kurzan
AU - Sankrit Kapoor
AU - Jennifer J Chung
AU - Michael Ibrahim
AU - Wilson Y Szeto
AU - Chase R Brown
PY - 2026
DA - 2026/08/19
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102065
UR - https://europepmc.org/article/MED/42948511
AB - 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 Thirty-nine patients underwent radial harvest with complete follow-up. Low PAVRO was not associated with postoperative change in any hand function metrics. Increased ulnar augmentation was associated with greater postoperative mean grip strength (P = .017) and fatigue resistance (P = .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.
SN - 2666-2736
ER -