Radial artery diameter decreases with increased femoral to radial arterial pressure gradient during cardiopulmonary bypass.

UNLABELLED

A clinically significant femoral to radial artery pressure gradient sometimes develops during cardiopulmonary bypass (CPB), but the mechanism responsible is not clear. We investigated when the pressure gradient developed and what mechanism could be responsible by comparing mean femoral to mean radial artery pressure and radial artery diameter in 75 male patients undergoing coronary artery bypass grafting. A pressure gradient > or =5 mm Hg (High-P) occurred in 38 patients, and the remaining 37 patients had pressure gradients <5 mm Hg (Low-P) at sternal closure. In High-P group, the pressure gradient was significantly greater (4.8 +/- 3.1 vs 1.0 +/- 3.1 mm Hg; P < 0.001) than in Low-P group, and the ratio of radial artery diameter to the diameter after induction of anesthesia was significantly decreased (0.79 +/- 0.12 vs 0.87 +/- 0.14; P = 0.006) at 5 min after aortic clamping. The pressure gradient and the arterial diameter changes persisted until sternal closure. There was a negative linear correlation between the pressure gradient (deltaP) and the radial artery diameter ratio (D) at sternal closure (D = -15.0deltaP + 16.6, r = 0.39, P < 0.001). In a subgroup of 11 High-P patients, palm temperature was significantly lower (P < 0.05) than that of 11 Low-P patients during and after CPB. We conclude that the femoral to radial artery pressure gradient develops by 5 min after aortic clamping during CPB and persists until sternal closure, and that radial artery constriction could be responsible for the pressure gradient.

IMPLICATIONS

A femoral to radial pressure gradient has been observed after cardiopulmonary bypass. Arterial vasodilation and vasoconstriction have been considered as causes for this gradient. We measured radial artery diameter using pulsed Doppler ultrasound and examined radial artery vasodilation versus vasoconstriction as possible mechanisms for the pressure gradient.