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Ann Thorac Surg 2002;74:296
© 2002 The Society of Thoracic Surgeons

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Correspondence

Is Allen’s test not reliable in the selection of patients for radial artery harvest?

^a Division of Cardiothoracic Surgery, CARE Hospital, The Institute of Medical Sciences, Road No. 1, Banjara Hills, Hyderabad-500034, AP, India

e-mail: sajjalr{at}yahoo.com

To the Editor

We read with interest the article written by Dr Jarvis and associates about the reliability of Allen’s test in selection of patients for radial artery harvest [1]. In their article, the authors concluded that at no cut-off point does Allen’s test perform satisfactorily as a discriminatory test, and they recommended more objective types such as Doppler ultrasound.

Two hundred and forty-one patients undergoing coronary artery bypass surgery received radial artery graft, which was harvested using extrafascial technique [2], as one of the conduits to bypass the stenosed coronary artery by our team from January 1997 through July 2001. In all of these patients, adequacy of collateral circulation of the nondominant hand was assessed preoperatively by Allen’s test and pulse oximetry, and intraoperatively by feeling the pulse in the distal part of the harvested radial artery after occluding the artery proximally. In all of these patients except 1, whose cut-off point for returning to normalcy of palmar rubor and reappearance of pulse wave on the pulse oximeter screen was 6 seconds or less, the pulse appeared promptly (less than 6 seconds) in the distal part of the radial artery after the proximal occlusion at the time of harvesting. With the combination of these three tests—negative Allen’s test, prompt reappearance of pulse wave on the pulse oxymeter screen (less than 6 seconds), and prompt reappearance of the pulse (less than 6 seconds) in the distal radial artery following the proximal occlusion—none of our patients suffered ischemia of the hand or digits postoperatively following radial artery harvest. All these tests correlated well in most of the patients. We have encountered false negativity of Allen’s test following dissection only once (0.4%), we did not divide the radial artery after dissection as we could not feel the pulse in the distal part of radial artery after its proximal occlusion. The radial artery was left in situ. We have not harvested a radial artery in those patients in whom Allen’s test was positive. We feel that negative Allen’s test in combination with pulse oximetry and palpability of distal radial artery pulse after its proximal occlusion is reliable to assess the adequacy of ulnar collateral circulation. Using this protocol, we did not encounter hand ischemia in any of our patients in a series of moderate size.

References

1. Jarvis M.A., Jarvis C.L., Jones P.R.M., Spyt T.J. Reliability of Allen’s test in patients for radial artery harvest. Ann Thorac Surg 2000;70:1362-1365.[Abstract/Free Full Text]
2. Kulshrestha P., Rao L., Garb J.L., Rousou J.A., Engelman R.M., Wait R.B. Use of extrafascially harvested radial artery for coronary artery revascularization: technical considerations. J Card Surg 1999;14:26-31.[Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Lokeswara Rao Sajja Gopichand Mannam Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sajja, L. R. Articles by Sompalli, S. Search for Related Content PubMed Articles by Sajja, L. R. Articles by Sompalli, S.