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Letters to the Editor

Re: Is the Allen test reliable enough?

Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, UK

Received 28 February 2008; accepted 11 March 2008.

^_* Corresponding author. Tel.: +44 114 271 5800; fax: +44 114 261 0350. (Email: m.asif{at}ntlworld.com).

Key Words: Radial artery • Coronary artery bypass grafting • Allen test

We agree with Kohonen et al. [1] that a negative Allen's test is safe to harvest the radial artery. This is well known. We have harvested the radial artery in 881 patients with a negative Allen's test without postoperative hand ischaemia [2]. Barner has done the same in 1364 patients [3] and Meharwal and Trehan in 3977 cases [4].

What to do in the event of a positive test is not as straightforward. Kohonen et al. report 23% tests as positive and suggest further investigation prior to radial artery harvest [1]. Other series have reported much lower rates of positive tests. At our institution 3.5% of Allen tests are positive. In a study of 2940 arms Hosokawa et al. found positive tests in 3.6% [5]. The incidence of a positive test is dependent on the time allowed for capillary refill, hyperextension of the hand and the length of the ischaemic interval prior to the release of the ulnar artery. We have previously described our technique in detail [2]. We would suggest in the event of a positive test to immediately repeat it using an alternative technique and taking great care to prevent hyperextension of the hand. This should reduce the number of positive tests and still allow safe harvest of the radial artery reserving more complex investigations for cases with two positive tests with two different techniques.

Footnotes

The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer.

References

1. Kohonen M, Teerenhovi O, Terho T, Laurikka J, Tarkka M. Is the Allen test reliable enough?. Eur J Cardiothoracic Surg 2007;32:902-905.[Abstract/Free Full Text]
2. Asif M, Sarkar PK. Three-digit Allen's test. Ann Thorac Surg 2007;84:686-687.[Abstract/Free Full Text]
3. Barner HB. Allen's test.. Ann Thorac Surg 2008;85:690.[Free Full Text]
4. Meharwal ZS, Trehan N. Functional status of the hand after radial artery harvesting: Results in 3977 cases. Ann Thorac Surg 2001;72:1557-1561.[Abstract/Free Full Text]
5. Hosokawa K, Hata Y, Yano K, Matsuka K, Ito O, Ogli K. Results of the Allen test in 2940 arms. Ann Plast Surg 1990;24:149-151.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohammed Asif Pradip Sarkar Permission Requests Google Scholar Articles by Asif, M. Articles by Sarkar, P. PubMed PubMed Citation Articles by Asif, M. Articles by Sarkar, P. Related Collections Education Coronary disease