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Letters to the Editor |
Is the Allen test reliable enough?
Heart Center, Tampere University Hospital, Tampere, Finland
Received 15 January 2008; accepted 17 January 2008.
* Corresponding author. Address: Heart Center, Tampere University Hospital, P Box 2000, 33521 Tampere, Finland. Tel.: +358 3 31165039; fax: +358 3 31165045. (Email: mika.kohonen{at}pshp.fi).
Key Words: Radial artery • Coronary artery bypass grafting • Ultrasonography • Allen test
First of all, I would like to thank all contributors for their valuable comments; I have been reading them with keen interest.
I fully agree with Agrifolio et al. that the Allen test is a subjective measure and, as such, dependent on the physician's experience [1]. In clinical practice in our department it is most often performed by two surgeons independently. In this setting it was done both in the Department of Clinical Physiology and by the operating surgeon. The Allen test was performed primarily, before the instrumental tests, and was therefore not influenced by ultrasonography or plethysmography.
You point out that the Allen test does not give any morphological information about the radial artery. I could not agree more with you on that point and, as you have noticed, we recommend ultrasonography in cases when we suspect that the vessel is diseased [2]. The statement about zero pressure in thumb during radial artery compression is an additional finding helping the decision-making after the instrumental tests. All patients with zero pressure in thumb during radial artery compression had a positive Allen test, which, according to our recommendation, should lead to further examinations.
Medico-legal aspects are not negligible. Neither is cost aspect. It is possible to perform ultrasonography and plethysmography on every candidate for radial artery harvesting. The question is if the benefit justifies the cost. I have no answer to this question and I doubt anyone has.
Unlu [3] and Sajja [4] both report an interesting method complementing the Allen test with pulse oximetry. It is an inexpensive and simple method that seems very promising. In our institution it is sometimes applied by cardiologists in cases when considering transradial approach. Surgeons have not adopted it. Both authors report impressive series that show the usefulness of this method even in the surgical practice.
As to the specific questions by Sajja, two patients (1.4%) had a positive Allen test but after negative ultrasonography and plethysmography had their radial artery harvested. Seven patients (4.8%) with negative Allen test did not undergo radial artery harvest as the instrumental tests suggested that the radial artery should be left alone. None of them had an absolute contraindication.
References
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