Allen's test: does it have any significance in current practice? 2015

Ashish H Shah, and Samir Pancholy, and Sanjay Shah, and Ashesh N Buch, and Tejas M Patel
Toronto General Hospital, Toronto, ON M5G 0B2, Canada. aashish.h.shah@gmail.com.

Percutaneous coronary intervention (PCI) performed through transradial access (TRA) has been consistently demonstrated to be safer than transfemoral access (TFA), mainly due to significantly reduced bleeding and vascular complications. Despite demonstrating better patient safety, acceptance of TRA as an access site of choice has remained low, with geographical variations. One of the relative contraindications to performing PCI through TRA is an abnormal Allen's test (AT), in which case the access site is usually switched to TFA. Bleeding and vascular complications are the "Achilles heel" for interventions through the TFA. The use of the AT is controversial given its low sensitivity in assessing both the collateral circulation of the hand and predicting ischemic complications. In this article, we present interesting data from the congenital heart and trauma literature that lead us to suggest the AT is an inadequate test to assess the collateral circulation of the hand. We think the case for its routine guideline-driven use is flawed.

UI MeSH Term Description Entries
D009203 Myocardial Infarction NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). Cardiovascular Stroke,Heart Attack,Myocardial Infarct,Cardiovascular Strokes,Heart Attacks,Infarct, Myocardial,Infarction, Myocardial,Infarctions, Myocardial,Infarcts, Myocardial,Myocardial Infarctions,Myocardial Infarcts,Stroke, Cardiovascular,Strokes, Cardiovascular
D002406 Catheterization, Peripheral Insertion of a catheter into a peripheral artery, vein, or airway for diagnostic or therapeutic purposes. Arterial Catheterization, Peripheral,Catheterization, Bronchial,Catheterization, Peripheral Arterial,Catheterization, Peripheral Venous,Peripheral Catheterization,Venous Catheterization, Peripheral,Bronchial Catheterization,PICC Line Catheterization,PICC Line Placement,PICC Placement,Peripheral Arterial Catheterization,Peripheral Venous Catheterization,Peripherally Inserted Central Catheter Line Insertion,Arterial Catheterizations, Peripheral,Bronchial Catheterizations,Catheterization, PICC Line,Catheterizations, Bronchial,Catheterizations, PICC Line,Catheterizations, Peripheral,Catheterizations, Peripheral Arterial,Catheterizations, Peripheral Venous,PICC Line Catheterizations,PICC Line Placements,PICC Placements,Peripheral Arterial Catheterizations,Peripheral Catheterizations,Peripheral Venous Catheterizations,Placement, PICC,Placement, PICC Line,Placements, PICC,Placements, PICC Line,Venous Catheterizations, Peripheral
D003097 Collateral Circulation Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels. Blood Circulation, Collateral,Circulation, Collateral,Collateral Blood Circulation,Collateral Circulation, Blood,Blood Collateral Circulation,Circulation, Blood Collateral,Circulation, Collateral Blood,Collateral Blood Circulations,Collateral Circulations,Collateral Circulations, Blood
D003935 Diagnostic Techniques, Cardiovascular Methods and procedures for the diagnosis of diseases or dysfunction of the cardiovascular system or its organs or demonstration of their physiological processes. Cardiovascular Diagnostic Technic,Cardiovascular Diagnostic Technics,Cardiovascular Diagnostic Technique,Cardiovascular Diagnostic Techniques,Diagnostic Technic, Cardiovascular,Diagnostic Technics, Cardiovascular,Diagnostic Technique, Cardiovascular,Technic, Cardiovascular Diagnostic,Technics, Cardiovascular Diagnostic,Technique, Cardiovascular Diagnostic,Techniques, Cardiovascular Diagnostic
D005263 Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Common Femoral Artery,Arteries, Common Femoral,Arteries, Femoral,Artery, Common Femoral,Artery, Femoral,Common Femoral Arteries,Femoral Arteries,Femoral Arteries, Common,Femoral Artery, Common
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D017534 Radial Artery The direct continuation of the brachial trunk, originating at the bifurcation of the brachial artery opposite the neck of the radius. Its branches may be divided into three groups corresponding to the three regions in which the vessel is situated, the forearm, wrist, and hand. Arteries, Radial,Artery, Radial,Radial Arteries
D062645 Percutaneous Coronary Intervention A family of percutaneous techniques that are used to manage CORONARY OCCLUSION, including standard balloon angioplasty (PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY), the placement of intracoronary STENTS, and atheroablative technologies (e.g., ATHERECTOMY; ENDARTERECTOMY; THROMBECTOMY; PERCUTANEOUS TRANSLUMINAL LASER ANGIOPLASTY). PTCA was the dominant form of PCI, before the widespread use of stenting. Percutaneous Coronary Revascularization,Coronary Intervention, Percutaneous,Coronary Interventions, Percutaneous,Coronary Revascularization, Percutaneous,Coronary Revascularizations, Percutaneous,Intervention, Percutaneous Coronary,Interventions, Percutaneous Coronary,Percutaneous Coronary Interventions,Percutaneous Coronary Revascularizations,Revascularization, Percutaneous Coronary,Revascularizations, Percutaneous Coronary

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