Transradial approach for cardiac catheterization in patients with negative Allen’s test

1. Transradial approach for cardiac catheterization
in patients with negative Allen’s test
J INVASIVE CARDIOL 2015;27(9):416-420
Michael Koutouzis, MD, PhD, FESC
Interventional Cardiologist
2nd
Cardiology Department
Hellenic Red Cross Hospital of Athens, Greece

2. • The major complication of the transradial catheterization is radial
artery occlusion, which can be permanent and is reported between
1% - 10% in different studies
• Allen’s test is a relatively easy way to document double artery
perfusion of the hand, excluding the risk of hand ischemia in case
of radial artery occlusion
• In many high volume radial centers the Allen’s test is no longer
used and its usefulness is questioned.
Background

3. Allen’s test

4. Real World Practice
• An international transradial practice survey
found that 58% of operators used modified
AT and 16% used Barbeau’s test, whereas
23% of operators did not perform any test
prior to performing TRA-PCI
Bertrand OF, Rao SV, Pancholy S, et al. Transradial approach for
coronary angiography and interventions: results of the first international
transradial practice survey. JACC Cardiovasc Interv.2010;3:1022-1031

5. Cohort Study
• 1035 procedures were performed via
radial approach.
• 588 procedures (56.8%) were coronary
angiography only,
• 447 (43.2%) underwent coronary
angiography plus ad hoc angioplasty
• Allen’s test was performed before the
procedure, with the results remaining
unknown to the operators in order to
reduce bias
• If pulse was not identified before
discharge, a doppler examination was
performed

6. Results
Baseline characteristics

7. Indications

8. Procedural characteristics

9. Procedural characteristics in
angioplasty

10. Complications

11. Radial Artery Thrombosis
• Radial artery thrombosis was observed in
6.2% of the negative Allen’s test group and
4.8% of the positive Allen’s test group
(P=.85), but was clinically silent in both
groups.

12. Predictors for preventing Radial Occlusion
regardless of the Allen’s test results
• Diameter of the sheath and its relation to
the size of the radial artery
• the post-procedural compression time
• the presence of anterograde flow in the
artery during hemostasis
• the use of anticoagulation
Yoo BS. Int J Cardiol. 2005;101:421-427
Nagai S, et al. Am J Cardiol. 1999;83:180-186
Pancholy SB. J Invasive Cardiol. 2009;21:101-104
Sanmartin, et al. Catheter Cardiovasc Interv. 2007;70:185-189

13. What the literatures say
• plethysmography and pulse oximetry improve the
sensitivity of the modified Allen’s test.
• Observations from the congenital heart disease
and vascular surgery spheres lead us to conclude
that Allen’s Test is a misleading and inaccurate test
of collateral blood supply to the hand.
• There may be no role for Allen’s testing to
determine the suitability of a patient for transradial
procedures
Barbeau GR et al. Am Heart J. 2004;147:489-493
Shah A et. al. J INVASIVE CARDIOL 2015;27(5):E70-E73
Ian C. Gilchrist, MD and Sunil V. Rao, MD . J INVASIVE CARDIOL 2015;27(5)

14. Conclusions
The transradial approach for coronary
angiography and ad hoc angioplasty can be
performed with :
•similar efficacy
•fewer local complications
•faster patient ambulation
•greater patient satisfaction
Regardless of the preprocedural
Allen’s test results

15. Thank you…