Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil.
Discipline of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.
Can J Physiol Pharmacol. 2021 Feb;99(2):231-236. doi: 10.1139/cjpp-2020-0432. Epub 2021 Feb 16.
There are controversies in the literature on the blood supply to the forearm after surgical removal of the radial artery in coronary artery bypass grafting (CABG). The objective was to investigate the arterial remodeling of the ulnar artery after the removal of the radial artery in myocardial revascularization by means of ultrasound examination with color Doppler in the pre- and post-operative periods. This paper describes an observational prospective study of the remodeling of the left brachial and ulnar arteries (donor arm) in 103 right-handed non-consecutive adult patients undergoing CABG with removal of the ipsilateral radial artery using the color Doppler ultrasound examination. In the ulnar artery, a significant increase ( < 0.05) was seen in the following measurements: lumen diameter by 13%, lumen area by 26%, peak systolic flow by 40%, and average flow by 46%. Intima-media thickness measured in the ulnar artery did not show a statistically significant difference ( = 0.22), except in diabetic patients ( = 0.007). We conclude that the ulnar artery undergoes positive physiological remodeling, adapting to the new requirements of chronic increase in flow after the ipsilateral removal of the radial artery to serve as a graft in CABG. There was no evidence of increased intima-media thickness, except in diabetic patients.
在冠状动脉旁路移植术（CABG）中桡动脉切除后前臂血液供应的文献中存在争议。目的是通过术前和术后彩色多普勒超声检查研究桡动脉切除后尺动脉的动脉重塑。本文描述了一项前瞻性观察研究，纳入 103 例右手非连续成年患者，均因 CABG 而切除同侧桡动脉，使用彩色多普勒超声检查对左肱动脉和尺动脉（供体臂）进行重塑的研究。在尺动脉中，以下测量值明显增加（<0.05）：管腔直径增加 13%，管腔面积增加 26%，收缩期峰值血流增加 40%，平均血流增加 46%。尺动脉的内-中膜厚度无统计学差异（=0.22），但在糖尿病患者中差异有统计学意义（=0.007）。我们得出结论，尺动脉发生了积极的生理性重塑，适应了同侧桡动脉切除后慢性增加血流的新需求，以作为 CABG 的移植物。除了糖尿病患者外，没有证据表明内膜-中膜厚度增加。
