Ann Thorac Surg 2005;79:755
© 2005 The Society of Thoracic Surgeons
Correspondence
The Allen Test
Zoltán Csiki, MD
3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, 4004 Debrecen, Hungary
Ildikó Garai, MD
Department of Nuclear Medicine, Medical and Health Science Center, University of Debrecen, 4004 Debrecen, Hungary
Zoltán Galajda, MD, PhD
Department of Cardiac Surgery, Medical and Health Science Center, University of Debrecen, 4004 Debrecen, Hungary
galajda{at}jaguar.dote.hu
To the Editor:
Our interest was aroused by the article by Abu-Omar and colleagues [1] concerning their study of radial and ulnar arteries by duplex ultrasonography before radial artery harvesting. Within the framework of a grant supported by the Medical University of Debrecen (Mecenatura Grant), we in our department now follow a multidisciplinary study protocol before radial artery harvest in patients with abnormal Allen test results. We completely agree that by ultrasonography provides valuable supplementary data to the Allen test and that together, both tests make removal of the radial artery safer.
Nevertheless, in our experience, patients have reported subjective complaints, such as cold hands or dysesthesia and coldness in certain fingers, in the later period after operation. We think these problems occur because of reduced blood supply in certain areas of the hand after radial artery harvest.
In some patients, we have observed developed radial and ulnar arteries by ultrasonography, but the anastomotic system is underdeveloped because of anatomic variations in the palmar arches between the two arteries (Fig 1). Therefore, in our institution, the examination starts with the Allen test, and ultrasonography is done only if the Allen test produces abnormal results. In addition, in every patient with abnormal Allen test results, we carry out a tissue perfusion examination of the hands with technetium 99m–labeled human serum albumin according to a protocol we developed. This protocol was presented at the 2003 Annual congress of the European Association of Nuclear Medicine in Amsterdam, August 2003 [2]. On the basis of our experience, we believe the combination of the three methods provides a detailed examination that offers safety in patient selection for radial artery harvesting before coronary artery bypass grafting operations.
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Fig 1. Postmortem angiogram showing undeveloped palmar arches. (From the collection of Dr Szabolcs Benis and Lajos Patonay, Department of Anatomy, Semmelweis Medical University, Budapest, Hungary.)
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We congratulate Abu-Omar and colleagues on their excellent work, which adds valuable data to this field.
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References
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- Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP. Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. Ann Thorac Surg. 2004;77:116–119[Abstract/Free Full Text]
- Garai I, Galajda Z, Benis SZ, et al. Hand perfusion with Tc-99m-HSA in patients expecting to undergo coronary bypass operation. Eur J Nucl Med. 2003;30(Suppl):261
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