J Korean Med Sci.  2015 Sep;30(9):1302-1307. 10.3346/jkms.2015.30.9.1302.

Evaluation of the Forearm Dominancy Artery for Invasive Vascular Procedure with 3D-CT Angiography

• Ki SH
• Choi JH

• KMID: 2344156
• DOI: http://doi.org/10.3346/jkms.2015.30.9.1302

Abstract

The aim of this study was to evaluate the vascular dominance in the forearm as a factor in determining the choice of invasive vascular procedures in arteries of the forearm, using 3D-computerized tomography (3D-CT) angiographies of 92 forearms. The diameters of the ulnar and radial arteries were measured just distal to the bifurcation of the brachial artery, at the midpoint between the bifurcation and the wrist, and at the wrist crease. In 79 cases, the ulnar artery was larger than the radial artery after the bifurcation of the brachial artery. However, no statistically significant difference was observed at either the mid-forearm or the wrist crease. In the remaining 13 cases, the diameter of the radial artery was larger or the same as that of the ulnar artery after the bifurcation, but at the more distal sites no regular pattern could be detected. The findings suggest that 3D-CT angiography offers valuable preoperative details of the forearm vessels for cases requiring invasive vascular procedures on the forearm.

Keyword

Radial Artery; Ulnar Artery; Vascular Dominance; 3D-CT Angiography

MeSH Terms

Adult
Aged
Aged, 80 and over
Angiography/*methods
Female
Forearm/blood supply/radiography/surgery
Functional Laterality
Humans
Imaging, Three-Dimensional/methods
Male
Middle Aged
Patient Selection
Preoperative Care/methods
Radial Artery/*radiography/*surgery
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods
Ulnar Artery/*radiography/*surgery
Vascular Surgical Procedures/methods
Young Adult

Figure

• 

  Fig. 1 Locations of vessel diameter evaluations. P 1, at the origin of both arteries just distal to the bifurcation of the brachial artery; P 2, at the mid-point between the bifurcation and the wrist crease; P 3, at the wrist crease. CIO, common interosseous artery.

• 

  Fig. 2 Result analysis. (A) Comparison of vessel diameters between the left and right forearm. Rt, right; Lt, left; U1, ulnar artery point 1; U2, ulnar artery point 2; U3, ulnar artery point 3, R1, radial artery point 1; R2, radial artery point 2; R3, radial artery point 3. (B) Comparison of vessel diameters between the radial and ulnar arteries of both forearms. ANOVA 2-way and t-test. (C) Vessel diameters according to age. Linear regression analysis. (D) Comparison of vessel diameters between males and females. (E) Comparison of vessel diameters between the radial and ulnar arteries of each gender. ANOVA 2-way and t-test.

Reference

1. Haerle M, Häfner HM, Dietz K, Schaller HE, Brunelli F. Vascular dominance in the forearm. Plast Reconstr Surg. 2003; 111:1891–1898.

2. Christie DR, Duncan GM, Glasson DW. The ulnar artery free flap: the first 7 years. Plast Reconstr Surg. 1994; 93:547–551.

3. Richardson D, Fisher SE, Vaughan ED, Brown JS. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg. 1997; 99:109–115.

4. Timmons MJ, Missotten FE, Poole MD, Davies DM. Complications of radial forearm flap donor sites. Br J Plast Surg. 1986; 39:176–178.

5. Crossland SG, Neviaser RJ. Complications of radial artery catheterization. Hand. 1977; 9:287–290.

6. Mandel MA, Dauchot PJ. Radial artery cannulation in 1,000 patients: precautions and complications. J Hand Surg Am. 1977; 2:482–485.

7. Katz AM, Birnbaum M, Moylan J, Pellett J. Gangrene of the hand and forearm: a complication of radial artery cannulation. Crit Care Med. 1974; 2:270–272.

8. Wallach SG. Cannulation injury of the radial artery: diagnosis and treatment algorithm. Am J Crit Care. 2004; 13:315–319.

9. Lee SH, Jung JM, Song MS, Choi S, Chung WY. Evaluation of cardiovascular anomalies in patients with asymptomatic turner syndrome using multidetector computed tomography. J Korean Med Sci. 2013; 28:1169–1173.

10. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet. 1961; 113:409–424.

11. Riekkinen HV, Karkola KO, Kankainen A. The radial artery is larger than the ulnar. Ann Thorac Surg. 2003; 75:882–884.

12. Doscher W, Viswanathan B, Stein T, Margolis IB. Hemodynamic assessment of the circulation in 200 normal hands. Ann Surg. 1983; 198:776–779.

13. Matthews JI, Gibbons RB. Embolization complicating radial artery puncture. Ann Intern Med. 1971; 75:87–88.

14. Ruch DS, Aldridge M, Holden M, Smith TL, Koman LA, Smith BP. Arterial reconstruction for radial artery occlusion. J Hand Surg Am. 2000; 25:282–290.

15. Bell RA, Schneider DS, Wax MK. Superficial ulnar artery: a contraindication to radial forearm free tissue transfer. Laryngoscope. 2011; 121:933–936.

16. Jones BM, O'Brien CJ. Acute ischaemia of the hand resulting from elevation of a radial forearm flap. Br J Plast Surg. 1985; 38:396–397.

17. Dumanian GA, Segalman K, Mispireta LA, Walsh JA, Hendrickson MF, Wilgis EF. Radial artery use in bypass grafting does not change digital blood flow or hand function. Ann Thorac Surg. 1998; 65:1284–1287.

18. Serricchio M, Gaudino M, Tondi P, Gasbarrini A, Gerardino L, Santoliquido A, Pola P, Possati G. Hemodynamic and functional consequences of radial artery removal for coronary artery bypass grafting. Am J Cardiol. 1999; 84:1353–1356. a8

19. Fuhrman TM, McSweeney E. Noninvasive evaluation of the collateral circulation to the hand. Acad Emerg Med. 1995; 2:195–199.

20. Prasetyono TO, Adianto S. The relationship between oxygen saturation and color alteration of a compromised skin flap: experimental study on the rabbit. Arch Plast Surg. 2013; 40:505–509.

21. Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP. Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. Ann Thorac Surg. 2004; 77:116–119.

22. Saint-Cyr M, Mujadzic M, Wong C, Hatef D, Lajoie AS, Rohrich RJ. The radial artery pedicle perforator flap: vascular analysis and clinical implications. Plast Reconstr Surg. 2010; 125:1469–1478.

23. Mathy JA, Moaveni Z, Tan ST. Perforator anatomy of the ulnar forearm fasciocutaneous flap. J Plast Reconstr Aesthet Surg. 2012; 65:1076–1082.