Ann Thorac Surg 2005;79:755-756
© 2005 The Society of Thoracic Surgeons
Correspondence
The Allen Test: Reply
Yasir Abu-Omar, MRCS,
Shafi Mussa, MRCS,
David P. Taggart, FRCS
Department of Cardiothoracic Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
yabuomar{at}doctors.org.uk
david.taggart{at}orh.nhs.uk
To the Editor:
We thank Dr Csiki and colleagues for their comments. Their protocol of using technetium 99m–labeled human serum albumin and duplex ultrasonography to assess hand perfusion in patients with abnormal Allen test is of high interest and is most welcome. The potential value of their technique is a reduction in the number of subjective complaints reported by patients after radial artery harvesting. Although a high proportion of their patients had subjective complaints, it is well documented after radial artery harvesting that objective neurologic or vascular deficit occurs in only 10% of patients [1].
Anatomic variations in the palmar arches are well recognized. A study by Ruengsakulrach and associates [2] demonstrated that the classic configuration of superficial palmar arch anatomy is found in only 10% of patients. However, there is always a marked anastomosis between the radial and ulnar arteries, which confirms the presence of a collateral supply to the hand [2]. This suggests that the majority of patients should be eligible for radial artery harvesting, as the incidence of major vascular disease in upper limb arteries is low [3]. Our main concern with the protocol of Dr Csiki and colleagues is that results from their technique may not directly translate into clinical outcome measures, and thus, a significantly higher proportion of patients (those with false-negative results) will be denied the potential benefits of arterial revascularization, even before the costs of the tests are considered.
In our study [4], we used the Allen test in combination with forearm arterial duplex ultrasonography to optimize the safe use of the radial artery. Using clinical outcome measures, we safely harvested the radial artery in 99% (285/287) of patients undergoing total arterial revascularization. In our experience, we have safely harvested the radial artery in well over 500 patients without any major complications. The combination of clinical assessment and duplex ultrasonography provides a simple and cost-effective method of examining the radial artery and the collateral circulation to the hand. These methods of assessment are readily available and therefore can be adopted by the vast majority of centers undertaking radial artery harvesting.
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References
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- Tatoulis J, Buxton BF, Fuller JA. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg. 1998;66:714–720[Abstract/Free Full Text]
- Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg. 2001;122:682–686[Abstract/Free Full Text]
- Kane-ToddHall SM, Taggart SP, Clements-Jewery H, Roskell DE. Pre-existing vascular disease in the radial artery and other coronary artery bypass conduits. Eur J Med Res. 1999;4:11–14[Medline]
- 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]
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