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Background Screening of the radial artery prior to harvesting as a conduit for coronary bypass may be performed clinically by the Allen test or by Doppler ultrasound. In a developing country like ours, the use of resources for Doppler studies may be questioned when Allen tests lead to a low rate of clinical sequelae. However, the rare occurrence of hand ischemia may be devastating and could justify the routine use of Doppler screening. This study aimed to address this question. Methods One hundred patients undergoing elective coronary artery bypass grafting were screened by the modified Allen test and Doppler ultrasound for suitability of use of a radial artery conduit. After harvesting, proximal and distal segments of the radial artery were subjected to histopathological examination. Results Of the 95 patients deemed suitable for radial artery grafting, 6 had mild calcification on Doppler ultrasound and 9 had calcification on histopathological examination. While Doppler showed atherosclerosis in 9 patients, only 6 had histopathological evidence of this (false-positive rate 3%). Of the 6 patients with histopathologic evidence of atherosclerosis, 2 were negative on Doppler (false-negative rate 2%). Conclusion Routine preoperative Doppler screening of the radial artery in the setting of limited resources is not justified. On the other hand, the time-tested Allen test which is easy to perform, interpret, and reproduce can be safely used as the sole screening test to harvest the radial artery.

Aims: Use of radial artery in coronary artery bypass grafting has been supported by the results of several histopathology and angiographic studies that have shown excellent short, medium and long term results. However the effect of coronary risk factors on its results may be of concern. This study was undertaken to correlate the association of major clinical risk factors with intimal hyperplasia and atherosclerosis in radial artery using preoperative doppler studies, intraoperative morphometry and postoperative histopathology (HP) and morphometry. Methods and results: This was a prospective study involving 100 patients undergoing coronary artery bypass grafting surgery in whom radial artery was used as a conduit. The radial artery was assessed using preoperative doppler ultrasound studies, intraoperative morphometry and postoperative histopathology (HP) and morphometry. In our series hypertension (69%), diabetes mellitus (54%), tobacco usage (33%) and dyslipidaemia (10%) were dominant coronary risk factors. A correlation was sought to be established between these risk factors and presence of radial artery disease. Presence of diabetes did not correlate with radial artery disease (p=0.487). Although the prevalence of disease was higher in patients having hypertension, dyslipidaemia and history of smoking, the numbers were not statistically significant. (p=0.7085 for hypertension, p=0.248 for dyslipidaemia and p of 0.387 for smoking). Conclusions: In view of the variable or no predictive value of these clinical risk factors, we conclude that radial artery should be used as a second arterial conduit after internal mammary artery in all patients undergoing coronary artery bypass grafting irrespective of clinical risk profile.