Residual Ischemia of the Hand After Removal of the Radial Artery in a Patient with Raynaud's Disease

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Abstract

A 73 year old man who underwent coronary revascularization with internal thoracic and left radial arteries grafts, developed acute ischemia of the hand. Preoperative Allen and intraoperative retrograde pulse tests established a good perfusion of the hand via ulnar artery. After surgery, the left hand was pale and cold without oximetric signal, despite of a good local motility and sensitivity. Two days after the procedure, signs of ischemia began to improve until the seventh post-operative day. Anew anamnesis oriented to the problem revealed an unsuspected Raynaud's disease not referred by the patient previously. Five months later, a vasospastic reaction of the hand was induced in the laboratory after cold exposure. Despite of the satisfactory evolution without local revascularization in this case, it is recommended a good preoperative screening of vasospasm phenomenon associated to Raynaud's disease previous to the selection of radial artery harvesting.