Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients.
BACKGROUND
To avoid ischemic hand complications, the percutaneous transradial approach is only performed in patients with patent hand collateral arteries, which is usually evaluated with the modified Allen's test (MAT). This qualitative test measures the time needed for maximal palmar blush after release of the ulnar artery compression with occlusive pressure of the radial artery. The objectives were to evaluate the patency of the hand collateral arteries and to compare MAT with combined plethysmography (PL) and pulse oximetry (OX) tests before the percutaneous transradial approach.


METHODS
Patients referred to the catheterization laboratory were prospectively examined with MAT, PL, and OX tests. PL readings during radial artery compression were divided into 4 types: A, no damping; B, slight damping of pulse tracing; C, loss followed by recovery; or D, no recovery of pulse tracing within 2 minutes. OX results were either positive or negative. Results of both tests were compared in 1010 consecutive patients.


RESULTS
MAT results < or =9 seconds on either hand were seen in 93.7% of patients. PL and OX types A, B, or C on either hand were seen in 98.5% of patients. On the basis of the MAT < or =9 seconds criteria, 6.3% of patients were excluded from the transradial approach, whereas with PL and OX types A, B, and C, only 1.5% of patients were excluded. There was more exclusion in men and with increasing age by using both methods.


CONCLUSIONS
In the evaluation of hand collaterals, PL and OX were found to be more sensitive than MAT. When applied to transradial approach screening, only 1.5% of patients were not suitable candidates for the transradial approach.
Institut universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Département de Cardiologie, Hôpital Laval, Ste-Foy, Quebec, Canada. Gerald.Barbeau@med.ulaval.ca
Gérald R
GR
Barbeau
François
F
Arsenault
Louise
L
Dugas
Serge
S
Simard
Marie Mai
MM
Larivière
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010991:Plethysmography; D017534:Radial Artery; D017535:Ulnar Artery; D014654:Vascular Patency