Reliability of Allen’s test in selection of patients for radial artery harvest

Jarvis, Martin; Jarvis, Claire L.; Jones, Peter R.; Spyt, Tomasz

doi:10.1016/s0003-4975(00)01551-4

Cited by 138 publications

(76 citation statements)

References 15 publications

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“…Return of the palmar blush within 5-10 seconds is typically considered normal (ie, a positive modified Allen test) and indicates adequate collateral circulation. False-positive and false-negative results are common, 35,36 and there is no consensus regarding the optimal cutoff time for a positive result.…”

Section: Assessing Dual Hand Circulationmentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

176

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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Section: Assessing Dual Hand Circulationmentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

176

133

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“…Doppler waveforms provide information on relative flow in the RA, ulnar artery, and palmar arch branches. 9 Measuring digit pressures may give a more precise reflection of the changes in hand blood flow after RA compression. 28 Another consideration in the use of the RA graft is that it is associated with a high rate of spasm.…”

Section: Radial Arterymentioning

confidence: 99%

Graft selection in cerebral revascularization

Baaj

Agazzi

Loveren

2009

FOC

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Cerebral revascularization constitutes an important treatment modality in the management of complex aneurysms, carotid occlusion, tumor, and moyamoya disease. Graft selection is a critical step in the planning of revascularization surgery, and depends on an understanding of graft and regional hemodynamics, accessibility, and patency rates. The goal of this review is to highlight some of these properties.

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“…15 Colour Doppler ultrasonography imaging is the gold standard method for assessing arterial patency and collateral competency in this setting, 16 but it is relatively resourceintensive and, there fore, seldom feasible or costeffective in routine clinical practice. Assessment at the bedside using the modified Allen test is widely accepted as the clinical standard.…”

Section: Resultsmentioning

confidence: 99%

“…Assessment at the bedside using the modified Allen test is widely accepted as the clinical standard. Despite this test's known diag nostic and prognostic shortcomings 16,17 and the low incidence of clinically significant ulnar artery occlusion, 18 results from modi fied Allen tests have served to exclude as many as 27% of patients from transradial approaches for cardiac catheterization, and an abnormal modified Allen test remains a relative contra indication for placement of invasive hemodynamic monitoring. 19 Plethysmography, which is the measurement of changes in amplitude of a photoelectric signal based on changes in blood volume pulsations, 20 and pulse oximetry (commonly referred to as the Barbeau test) have been described as alternatives; how ever, the need for a dedicated oximeter has precluded its wide spread use.…”

Section: Resultsmentioning

confidence: 99%

“…A 5second cutoff for arterial patency was chosen because it has been shown to maximize diagnostic accuracy (79.6%), with a sensitivity of 75.8% and specificity of 81.7%. 16 We conducted the smartphonebased evaluation by using the Instant Heart Rate application (version 4.5.0; Azumio) on an iPhone 4S (Apple). We selected this application because it per mits direct visualization of the photoplethysmography tracing on the screen, is commercially available free of charge on both Apple and Android operating systems and is the most down loaded heart rate-monitoring application worldwide.…”

Section: Randomization and Maskingmentioning

confidence: 99%

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