Title: Comparison of Modified Allen’s Test with Measurement of Radial Artery Diameter by Doppler and its Suitability for Transradial Coronary Angiography - An Observational Study
Authors: Adeel Majeed Belim, Sheikh Mohamad Tahir, Shubana Ashraf, Rajiv Agarwal
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.119
Abstract
Background: The feasibility of using modified Allen’s tests and Doppler ultrasonography to evaluate arterial circulation and diameters in the forearm arteries for transradial coronary angiography, and the correlation of these tests with the complications were examined.
Material & Methods: This was an observational study and the hand circulation of 70 patients scheduled for transradial coronary angiography was assessed by Modified Allen’s test and Doppler ultrasonography. Findings of the positive modified Allen’s test and diameter of the radial, ulnar arteries were recorded and compared for the various demographic, risk factors profile, vascular access complications and procedural outcomes.
Results: A total of 70 patients were evaluated and 16 had a positive modified Allen’s test. The mean diameter of right and left radial artery was 2.5±0.4mm and 2.4±0.4mm respectively (p=0.470). The mean diameter of right and left ulnar artery was 2.7±0.4mm and 2.7±0.4mm respectively (p=0.782). Highly significant difference was found between the respondents (p<0.001) when forearm arteries was compared to each other. There was no relationship of the size of the radialandulnar artery with age, body Mass Index (BMI) and various risk factors studied. However, the diameter of the forearm arteries showed good correlation with each other. Significant correlation was found between arterial spasm (p<0.001) and crossover (p=0.010) & modified Allen’s test. Statistically significant correlation was found between Doppler measured right radial artery diameter and arterial spasm (p=0.001). The positive Modified Allen’s test and Doppler measured Forearm artery diameters when correlated, then statistically significant difference was found suggestive of smaller diameters were found in patient with a positive Modified Allen’s test.
Conclusions: Use of Modified Allen’s test as a screening tool to assess the collateral circulation of hand correlates well with the occurrence of complication and there has been a significant correlation between the positive Modified Allen’s test and Doppler measured radial artery diameter and the occurrence of complications in our study. A positive modified Allen’s test completely obviates the need for Doppler assessment and provides no additional benefit rather we exercise caution and change the access site if possible.
Keywords: Allen’s Test, Modified Allen’s Test, Radial Artery Diameter, Transradial Coronary Angiography.
References
- Rao SV, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: A report from the National Cardiovascular Data Registry. J Am Coll CardiolIntv 2008;1: 379–386.
- Dr Sanjit S Jolly MD, Prof Salim Yusuf MBBS, Prof John Cairns MD, Prof Kari Niemelä MD, Denis Xavier MD, Prof Petr Widimsky MD, Prof Andrzej Budaj MD, Matti Niemelä MD, Vicent Valentin MD, Prof Basil S Lewis MD, Alvaro Avezum MD, Prof Philippe Gabriel Steg MD, Sunil V Rao MD, Peggy Gao MSc, Rizwan Afzal MSc, Prof Campbell D Joyner MD, Susan Chrolavicius BScN, Shamir R Mehta MD. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial for the RIVAL trial group The Lancet - 23 April 2011 (Vol. 377, Issue 9775, Pages 1409-1420) DOI: 10.1016/S0140-6736(11)60404-2.
- Nagai S1, Abe S,Sato T, Hozawa K,Yuki K, Hanashima K, Tomoike H. Ultrasonic assessment of vascular complications in coronary angiography and angioplasty after transradial approach. Am J Cardiol. 1999 Jan 15; 83 (2):180-6.
- Choussat, A. Black1, I. Bossi, J. Fajadet and J. Marco. Comparison of transradial vs transfemoral arterial access. Eur Heart J 2000; 21: 662–667.
- Yokoyama et al. Anatomic Variations of the Radial Artery in Patients Undergoing Transradial Coronary Intervention. Catheterization and Cardiovascular Interventions 49:357–362 (2000).
- Randheer Pal, Dr. Rajeev Bagarhatta, Dr. Monika Rathore. A Descriptive Comparison of Diameter of Radial and Ulnar Arteries Using Doppler Ultrasonography. Indian Journal of Basic and Applied Medical Research; March 2014: Vol.-3, Issue- 2, P.373-379.
- Tariq Ashraf, Ziauddin Panhwar, Sultana Habib, Muhammad Anis Memon, Fahad Shamsi, JavedArif. Size of radial and ulnar artery in local population. JPMA 60:817; 2010.
- Doscher W, Viswanathan B, Stein T, Margolis IB. Hemodynamic assessment of the circulation in 200 normal hands. Ann Surg1983; 198:776-9.
- Yee Jim Loh, Masakazu Nakao, Wei Ding Tan, Chong Hee Lim, Yong Seng Tan, Yeow Leng Chua Asian Cardiovasc Thorac Ann. 2007 August; 15(4): 324–326.
- Mika Kohonen, Ossi Teerenhovi, Tiina Terho, Jari Laurikka, and Matti Tarkka. Is the Allen test reliable enough? Eur J Cardiothorac Surg (2007) 32 (6):902905 doi: 10. 1016 / j. ejcts. 2007.08.017
- Abdelaal et al. Jacc: cardiovascular interventions, vol.-, no.-2013 Clinical Score to Predict Radial Failure – 2013.
- Ian C. Gilchrist, MD: Is the Allen‟s Test Accurate for Patients Considered for Transradial Coronary Angiography? JACC Vol. 48, No. 6, 2006 Correspondence 1287 September 19, 2006:1283–8.