CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Vascular Communications of the Hand in Patients Being Considered for Transradial Coronary Angiography
Is the Allen’s Test Accurate?
Michael J. Greenwood, MBBS, FRACP*,
Anthony J. Della-Siega, MD,
Eric B. Fretz, MD,
David Kinloch, MD,
Peter Klinke, MD,
Richard Mildenberger, MD,
Malcolm B. Williams, MD and
David Hilton, MD
Victoria Heart Institute, Victoria, British Columbia, Canada
Manuscript received February 5, 2005;
revised manuscript received June 29, 2005,
accepted July 11, 2005.
* Reprint requests and correspondence: Dr. Michael J. Greenwood, Gold Coast Heart Center, Spendelove Street, Southport 4218, Australia (Email: greenie3{at}bigpond.net.au).
OBJECTIVES: The purpose of this study was to assess the accuracy of the Allen’s test (AT) in predicting hand ischemia in patients undergoing transradial coronary angiography.
BACKGROUND: Patients with poor vascular communications between the radial artery (RA) and ulnar artery (UA), as indicated by an abnormal AT, are usually excluded from transradial coronary angiography to avoid ischemic hand complications.
METHODS: Over a four-month period, patients undergoing coronary angiography were screened for AT time. Circulation in the RA, UA, principal artery of the thumb (PAT), and thumb capillary lactate were measured before and after 30 min of RA occlusion.
RESULTS: Fifty-five patients were studied (20 normal, 15 intermediate, 20 abnormal). Three patients with an abnormal AT were excluded, owing to absence of detectible flow in the distal UA. Patients with an abnormal AT were all men, had a larger RA (3.4 vs. 2.8 mm; p <0.001), and smaller UA (1.9 vs. 2.5 mm; p <0.001), compared with patients with a normal AT. After 30 min of RA occlusion in patients with abnormal AT, blood flow to the PAT improved (3.2 to 7.7 cm/s; p <0.001) yet remained reduced relative to patients with normal AT (7.7 vs. 21.4 cm/s; p <0.001. Thumb capillary lactate was elevated in patients with an abnormal AT (2.0 vs. 1.5 mmol/l; p = 0.019).
CONCLUSIONS: After 30 min of RA occlusion, patients with an abnormal AT showed significantly reduced blood flow to the thumb and increased thumb capillary lactate (compared with patients with a normal AT) suggestive of ischemia. Transradial cardiac catheterization should not be performed in patients with an abnormal AT.
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Abbreviations and Acronyms
| | ANOVA = analysis of variance | | AT = Allen’s test | | PAT = principle artery of the thumb | | RA = radial artery | | UA = ulnar artery |
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