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Positive allen test following radial coronary angiogram

Posted Dec 08 2008 8:54pm

This paper was presented in the just concluded 60th Annual scientific sessions of cardiological society of India , Chennai.India


Venkatesan   sangareddi , G.Gnanavelu, R.Alagesan,V.Jaganathan.

Department of cardiology, Madras Medical College, Chennai.


                          Radial   artery   has become the   major access   site for the interventional cardiologist in recent years. Radial approach has provided increased patient comfort and   less access site complication. Many   of   the    complications   are   unique to radial approach mostly due to   anomalies of origin, and course while others are   hardware related .Unlike femoral arterial access ,   compromise of blood supply to hand is never considered a   threat because of dual blood supply to hand  .But the fact   is that,   it   could be sub-clinical   and the hand is rarely assessed for vascular insufficiency after a radial procedure.

             The aim of the study is to assess the   impact of    radial   procedures   on the   blood flow   to   hand . 20 patients who had undergone routine   radial coronary   angiogram   formed the study population. All patients had negative Allen’s test prior to the procedure. The mean procedure time was    25mts (18-45) .Standard   hardwares were used. Difficulty in crossing at forearm and    subclavian    was observed in   4   patients. Extravasation of dye   in forearm was observed in two. Allen test   was   done 24 hours   after sheath removal and   repeated 48 hours after the procedure .   4 patients    showed positive Allen test   at 24hrs. One   patient    regained   Allen negativity at   48hours. The incidence of positive Allen test at   24 hours is 20%. The compromised blood flow was correlated with the   procedure time, and a difficult catheter course .

                 We propose,   radial procedures especially , when prolonged has a potential to compromise palmar arch flow .This phenomenon   is   either   permanent   or transient   and   may be attributable to enhanced   endothelial tone and sheath related injury. Irreversible   compromise   of blood flow to   palmar arch   may   also occur   in radial dominant hands. Further enhanced   sympathetic tone can   spill over to ulnar artery as well .  

             It is concluded, interventions through radial route has hitherto unreported adverse effect   of   “Post procedural   positive   Allen test”  . It   implies , radial   procedures   could   convert   a dual blood supply   pattern of the   hand to ulnar dependent   uni-modal   blood flow   in a significant   subset of patients. This is important    to recognise, as it    precludes further radial procedures in the same patient.


Final message

Hand function could be as vital as our heart’s ,   please handle with care to avoid this complication


Click on the slide to download PPT presentation


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