Abstract
Background: Despite a negative Allen test, some patients develop hand ischemia after radial artery
harvesting. The presence of large interosseous collaterals may reduce the sensitivity
of Allen test. To evaluate the combination of ulnar flow measurements and the Allen
test as an effective screening technique, we performed Doppler ultrasonography during
Allen's maneuver. Methods: The Allen test was used to select candidates for harvesting radial artery from 80
patients undergoing coronary bypass surgery. Results: Of 71 patients with a negative Allen test, one patient developed hand ischemia. This
patient was one of six (7.5 %) possessing low ulnar flow levels (less than 40 ml/min/m2 during compression of the radial artery). This low-flow group had a higher risk for
ischemia of the 71 patients with a negative Allen test. The post-operative flow differed
greatly from the pre-operative flow in eight patients (11.3 %), which was likely due
to large sacrificed interosseous collaterals. Conclusion: Combined use of ulnar flow measurement with the Allen test appears to increase the
sensitivity of the Allen test. Neither test, however, is sufficient for a group of
patients with large interosseous collaterals.
Key Words
Radial artery - Allen test - doppler ultrasound - hand ischemia
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Noriyuki Tabuchi MD, PhD
Tokyo Medical and Dental University, Graduate school of medicine, Department of cardiothoracic
surgery
Yushima 1-5-45, Bunkyo-ku,
Tokyo, 113-8519
Japan
Phone: + 81-3-5803-4270
Fax: + 81-3-5803-0141
Email: n-tabu.tsrg@tmd.ac.jp