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Looking forward for update on this case

> On Nov 14, 2020, at 9:39 AM, Bill Schroedter <[log in to unmask]> wrote:
> 
> 
> Interesting Brian. I am assuming the patient has no hand symptoms and no signs of embolization.
> I would tend to agree with you. While we know that some people have an incomplete palmar arch, it would seem like the most logical explanation would be some sort of anomaly of the arch.
>  
> I will pose some additional questions. Could an interosseous or median artery supply segments of the arch without a direct or large vessel connection to it. Could the arch not have a direct large vessel connection to the digital arteries? While you were there, did you obtain finger pressures? Perhaps that could suggest an indirect pathway. Did you try to use duplex to image the arch? Difficult but perhaps that could provide some additional clues.  
> Nonetheless, reluctance to harvest would seem prudent.   
>  
> Thanks for sharing.  Let us know.
>  
> Bill
>  
>  
> William B Schroedter, BS, RVT, RPhS, FSVU
> 4120 Woodmere Park Blvd
> Suite 8B
> Venice, Florida  34293
> www.qualityvascular.com
> www.virtualveincenter.com
>  
>  
> From: UVM Flownet <[log in to unmask]> On Behalf Of Brian Wirick
> Sent: Friday, November 13, 2020 8:20 PM
> To: [log in to unmask]
> Subject: Re: Radial Artery Studies
>  
> I did have the thought about a big interosseous artery but in that case, you wouldn’t lose pulsatility at all, correct?
> 
> Sent from my iPhone
> 
> 
> On Nov 13, 2020, at 14:05, Steve Knight <[log in to unmask]> wrote:
> 
> 
> Perhaps an anomaly of the vasculature such as a persistent median artery?
> <image.png>
>  
>  
> On Fri, Nov 13, 2020 at 12:37 PM Brian Wirick <[log in to unmask]> wrote:
> Had an interesting case this week:
> 43 year old for CABG needs radial harvesting.
> 
> Arteries look normal. Allen's test is where things get confusing for us:
> 
> right #1: flatline with radial compression. Decrease in pulsatility with ulnar compression
> right #2-5: flatline with radial compression. Flatline with ulnar compression.
> 
> 
> left digits: all flatline with radial compression. 2 and 3 show decrease in pulsatility with ulnar compression and 1,4,5 are normal with ulnar compression.
> 
> Can anyone explain the results of the right hand allen's test?
> 
> Thank you in advance, 
> Brian
> 
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>  
> --
>        Steve Knight
> 
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