title: Palmar arch anatomy: Ajmer Working Group classification.
abstract: BACKGROUND
  Forearm arteries are frequently used as workhorse site for cardiac catheterization, bypass grafting and haemodialysis access. There is paucity of data on palmar circulation in live human being and only cadaveric data are available till date. We, therefore, made an attempt to look at the various patterns of sufficient or insufficient palmar arch circulation and various anomalies of forearm arteries, to discuss their clinical implications.
  
  
  RESULTS
  We obtained the forearm and hand arteriograms of patients (n = 302) through radial (n = 200) and ulnar routes (n = 102). Modified Allen's test was normal in all of our patients. On the basis of predetermined parameters angiograms were analysed and findings were divided into three groups. These three groups were further classified as type A, type B, type C superficial palmar arch.
  
  
  CONCLUSIONS
  We concluded that type A superficial palmar arch is most suitable for providing adequate collateral circulation in case of harvesting of forearm vessel, whereas type C superficial palmar arch appears to be highly susceptible for digital ischemia in case of radial or ulnar artery occlusion. Modified Allen's test alone is not justifiable for documenting good collateral circulation and it should be supplemented by other tests to document good collateral circulation before proceeding to any radical procedure.
authors.affiliation: Post Graduate Department of Cardiology, JLN Medical College & Associated Group of Hospitals, Ajmer, Rajasthan, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Gokhroo
authors.affiliation: Post Graduate Department of Cardiology, JLN Medical College & Associated Group of Hospitals, Ajmer, Rajasthan, India bisht2416@gmail.com.
authors.forename: Devendra
authors.initials: D
authors.lastname: Bisht
authors.affiliation: Post Graduate Department of Cardiology, JLN Medical College & Associated Group of Hospitals, Ajmer, Rajasthan, India.
authors.forename: Sajal
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Post Graduate Department of Cardiology, JLN Medical College & Associated Group of Hospitals, Ajmer, Rajasthan, India.
authors.forename: Kamal
authors.initials: K
authors.lastname: Kishor
authors.affiliation: Post Graduate Department of Cardiology, JLN Medical College & Associated Group of Hospitals, Ajmer, Rajasthan, India.
authors.forename: Bhanwar
authors.initials: B
authors.lastname: Ranwa
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002932:Cineangiography; D003097:Collateral Circulation; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D058017:Vascular Grafting / Q000009:adverse effects; D054079:Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Allen test; Palmar arch; cardiac catheterization