CORRESPONDENCE: LETTER TO THE EDITOR
Is the Allen’s Test Accurate for Patients Considered for Transradial Coronary Angiography?
Ian C. Gilchrist, MD*
* Penn State Heart and Vascular Institute, 500 University Drive, Hershey, Pennsylvania 17033-0850 (Email: Icgl{at}psu.edu).
As a strong proponent of transradial cardiac catheterization who long ago stopped using the Allen’s test, I read the study by Greenwood et al. (1) with great interest. As correctly pointed out in the report, no published study of hand ischemia has been reported after transradial procedures nor after surgical harvest related to the state of the Allen’s test. This suggests that the hand circulation is very resilient and the sequela of hand ischemia is at least rare. Complications from indwelling radial arterial lines reported in the critical-care literature have likewise not shown an association with the results of an Allen’s test. Several high-volume transradial operators have told me that they too have abandoned the traditional Allen’s test as not clinically relevant.
It is reasonable to expect ischemia in any poorly collateralized vascular bed subjected to vascular occlusion as found by the researchers when they occluded certain radial arteries. Total occlusion of the femoral artery for 30 min will likewise probably cause elevated lactates and signs of limb ischemia. Multicenter trials of femoral closure devices and drug trials used during interventional procedures provide a real-world testimony of the hazards of transfemoral catheterization that is without precedent in the transradial catheterization experience (2). The results presented by Greenwood et al. (1) do lend support to the hypothesis that the Allen’s test may identify patients with the potential for poor collateral flow. Conversely, the conclusions reached by the investigators that transradial procedures should not be done in patients with an abnormal Allen’s test is not supported by the actual experience but rather appears to be a premature leap from a simple physiology experiment to a practice guideline with no weight of clinical evidence. Most patients with an abnormal Allen’s test, if presented the facts and given a choice, would probably stick with a transradial procedure and a theoretical risk of hand ischemia than opt for the transfemoral approach with a real risk of a vascular complication.
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- Greenwood MJ, Della-Siega AJ, Fretz EB, et al. Vascular communications of the hand in patients being considered for transradial coronary angiography: is the Allen’s test accurate? J Am Coll Cardiol 2005;46:2013-2017.[Abstract/Free Full Text]
- Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: systematic overview and meta-analysis of randomized trials J Am Coll Cardiol 2004;44:349-356.[Abstract/Free Full Text]
Related Article
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- Michael Greenwood
J. Am. Coll. Cardiol. 2006 48: 1288.
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