| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2002;74:296
© 2002 The Society of Thoracic Surgeons
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
This article has been cited by other articles:
|
|
 |
|
  L. R. Sajja Assessment of ulnar collateral circulation by the Allen test in patients undergoing radial artery harvest Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 755 - 755. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Pappalardo, C. Corno, A. Franco, G. Giardina, A.M. Scandroglio, G. Landoni, G. Crescenzi, and A. Zangrillo Reduction of hemodilution in small adults undergoing open heart surgery: a prospective, randomized trial Perfusion, September 1, 2007; 22(5): 317 - 322. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Ronald, A. Patel, and J. Dunning Is the Allen's test adequate to safely confirm that a radial artery may be harvested for coronary arterial bypass grafting? Interactive CardioVascular and Thoracic Surgery, August 1, 2005; 4(4): 332 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. R. Sajja, G. Mannam, N. R. Pantula, and S. Sompalli Role of Radial Artery Graft in Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 2005; 79(6): 2180 - 2188. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
