Allen Test Research Articles

Der Doppler-Hohlhand-Test

In 384 hands the patency of the arterial arch was investigated by means of both the Allen test and the Doppler palmar arch test as developed by the authors. While the Allen test is purely subjective and gives a high proportion of false results especially in shocked patients, the Doppler palmar arch test is based on two objective criteria: 1. Demonstration of reversed flow in the distal section of the radial artery on proximal compression. 2. Demonstration of pulsatile flow in the radial thumb artery even on compression of the radial artery. The Doppler palmar arch test eliminates all negative aspects of the Allen test and is therefore definitely more reliable than the latter. It is easy to perform for investigators having little experience with Doppler sonography. The time consumed is not greater than with the Allen test.

Is the Allen test reliable enough?

Is the Allen test reliable enough?

Assessment of ulnar collateral circulation by the Allen test in patients undergoing radial artery harvest

Assessment of ulnar collateral circulation by the Allen test in patients undergoing radial artery harvest

The Allen test is not adequate enough for the screening of hand circulation

The Allen test is not adequate enough for the screening of hand circulation

Arterial and end-tidal carbon dioxide pressure differences during laparoscopic colorectal surgery

Arterial and end-tidal carbon dioxide pressure differences during laparoscopic colorectal surgery

Registro prospectivo de avaliação da segurança e eficácia da técnica ulnar na realização de procedimentos coronários

INTRODUÇÃO: O uso da técnica radial na realização de procedimentos coronários reduz a incidência de complicações vasculares no sítio de punção, os custos e o tempo de permanência hospitalar, além de propiciar maior conforto ao paciente. No entanto, seu emprego encontra-se prejudicado em 5% a 15% dos casos por variações anatômicas da artéria radial, vasoespasmo e teste de Allen negativo. O objetivo do trabalho é avaliar a segurança e a eficácia do acesso ulnar como via alternativa na realização dos procedimentos coronários. MÉTODO: Pacientes submetidos a procedimento coronário pela via ulnar foram incluídos em um registro prospectivo. Foram avaliados: o sucesso da técnica, definido como realização de coronariografia com adequada opacificação arterial e intervenção coronária percutânea (ICP) com estenose residual < 30%, sem necessidade de mudança da via de acesso; os tempos de procedimento e de fluoroscopia; e as complicações intra-hospitalares e aos 30 dias de seguimento. RESULTADOS: Entre maio de 2007 e maio de 2008, 102 procedimentos coronários foram incluídos no registro. A média de idade foi de 61 ± 11 anos, sendo 53% do sexo feminino e 34% de diabéticos. A taxa de sucesso foi de 94,5% e 100% para coronariografia e ICP, respectivamente. Houve baixa incidência de complicações, incluindo 2% de oclusão assintomática da artéria ulnar e 1% de hematoma, sem necessidade de reparo vascular ou transfusão sanguínea. CONCLUSÃO: O acesso ulnar mostrou-se seguro e eficaz na realização de procedimentos coronários, com elevada taxa de sucesso e virtualmente isento de complicações no sítio de punção. Tratase de uma via de acesso alternativa em serviços que utilizam a técnica radial rotineiramente.

Study of ulnar and radial arteries at wrist level in smokers

We aimed to assess the blood flow through the radial and ulnar arteries at the wrist in chronic smokers, after a clinical observation that the ulnar artery is often difficult to palpate in chronic smokers. Sixty-four smokers and 36 non-smokers were recruited. The blood vessels were examined by palpation, and we used the hand-held Doppler and the Allen test to illustrate the dependence of the blood supply on one or the other vessel. The study showed that in 57 of the 64 chronic smokers (89%) the ulnar artery was difficult to palpate and in 28 (44%) dominant and 35 (55%) non-dominant hands blood flow through the ulnar artery was assessed as being poor using the hand-held Doppler. The Allen test was, however, within the normal limit of two seconds in all patients in this study.

Ulnar Artery as Access Site for Cardiac Catheterization: Anatomical Considerations

Transradial approach to coronary angiography and angioplasty has been widely accepted in the last few years. As an alternative approach from the forearm, with some potential advantages, we decided to test the transulnar approach as a first-choice strategy. Transulnar approach was tried in 131 patients. In 29 patients there was no palpable ulnar artery or Allen test was negative. From the remaining 92 patients we performed successful coronary angiography and angioplasties in 59 patients (64% success rate in those who had palpable artery). The most frequent reason for access site failure (54.5% of all failed procedures) was inability to introduce wire despite good arterial flow. We found that the ulnar artery was not the largest artery of the forearm (mean diameter 2.76 +/- 0.08 mm compared with radial artery 3.11 +/- 0.12 mm) and had relatively frequent anatomical anomalies-11.9%. There were no major local complications, with very few minor complications. Spasm frequency was 13.6%, which is higher than that reported for transradial studies. Transulnar artery approach is feasible for cardiac catheterization: however, it has higher access site failure rates in an unselected patient population. It could be used as an alternative option in selected patients, but operators must be prepared to overcome frequent anatomical anomalies and spasm.

Ischaemia of the hand after harvest of a radial forearm flap

The development of ischaemia in the hand after harvest of a radial forearm flap is extremely rare. Previous cases have been caused by anatomical anomalies or conditions that may have been detectable by ultrasonography. We report the development of ischaemia after harvest of a radial forearm flap despite a normal preoperative Allen's test and a normal Doppler ultrasound scan, in a non-smoker with no evidence of peripheral vascular disease. Angiographic appearances suggested that the ischaemia may have been secondary to an incomplete superficial palmar arch. This case highlights the potential for development of ischaemia despite normal preoperative investigations, with obvious ramifications for obtaining consent.

Total upper and lower eyelid replacement following thermal burn using an ALT flap – a case report

Upper and lower eyelid unilateral full thickness reconstruction in a patient with no available adjacent tissues because of burns or trauma sequelae is a surgical challenge. A case of severe thermal burn with unilateral complete defect of both upper and lower eyelids is reported, together with the surgical technique of reconstruction. The patient was a 65-year-old man who sustained deep burns of the head and neck with upper airway burns after falling into a fireplace. After tracheostomy and acute resuscitation, he underwent escharectomy and coverage of his head and neck burns with split thickness skin grafts and with full thickness skin grafts to the eyelids. There was incomplete take of the skin grafts to the upper and lower left eyelids. In these areas, infection and loss of the tarsum and subsequent eyelid retraction led to exposure keratitis and blurred vision. After healing and respiratory rehabilitation, he was referred to our microsurgical unit for upper and lower eyelid reconstruction. A free forearm flap was first considered, but the Allen test was negative. Therefore, a free anterolateral thigh (ALT) flap was chosen to provide skin eyelid coverage. The flap was harvested including fascia and centred on one perforator. The levator muscle stump and conjunctiva from both upper and lower cul-de-sacs were dissected and advanced. Flap vessels were anastomosed to the superficial temporal artery and vein. The conjunctiva and the fascia replaced the new inner upper and lower lamella. To our knowledge, this is the first report of the use of a perforator flap, the ALT flap, in full thickness reconstruction of both upper and lower eyelids and may be a reliable option in such selected and challenging situations.

Is the Allen test reliable enough?

The Allen test is a widely used screening method of hand circulation. Our aim was to study whether the Allen test alone gives sufficient information for harvesting the radial artery in coronary artery bypass grafting. One hundred and forty-five patients scheduled for coronary artery bypass grafting underwent the Allen test, upper arm Doppler ultrasonography and digital plethysmography. In ultrasonography both anatomical and circulatory measurements were performed. The Allen test was then compared with more objective tests and sensitivity; specificity and diagnostic accuracy were calculated. Most of the patients had a negative Allen test, but 23% were positive (abnormal). Ultrasound scanning revealed anatomical anomalies in 10 patients and circulatory deficits in 17 patients. Thirteen patients had both circulatory and anatomical abnormalities. Sensitivity of the Allen test was 73.2% and specificity 97.1% based on our findings. There were no abnormalities in the recovery of the arms with harvested radial grafts. The Allen test is a good and valid screening test for the circulation of the hand. If the Allen test is negative it is safe to harvest the radial artery. If it is positive further examinations are needed to ensure safe harvesting of the radial artery.

Three-Digit Allen’s Test

Hand ischemia after radial artery intervention remains a rare but serious complication. Allen's test is widely used to assess the adequacy of ulnar collateral circulation to the hand. There have been documented cases of hand ischemia after radial artery intervention even with a negative test. We describe a modification of Allen's test based on the anatomy of the radial artery branches that could potentially decrease the number of false negative tests.

Transradial approach for noncoronary angiography and interventions

The purpose of this study was to retrospectively evaluate the feasibility and safety of a transradial approach for non-coronary angiography and interventions. Generally, the transradial approach is used for coronary angiography and intervention around the world, and experiences have been widely reported. However, few large studies have examined the transradial approach for vessels other than the coronary or cerebral artery. Subjects comprised 329 patients who underwent a total of 400 procedures (285 abdomens, 68 pelvises, and 47 lower limbs) with transradial angiography and interventions between January 1999 and June 2006. Normal Allen test results were confirmed before all procedures. A 130- or 150-cm long 4F catheter modified to our own design was used for angiography and interventions such as transarterial embolization or transarterial chemotherapy. Radial artery access was unachievable in 19 of the 400 procedures (4.8%). The radial artery was injured during 1 procedure (0.2%). In the remaining 380 procedures, sufficient angiography was obtained to grasp the condition of indispensable vessels for diagnosis and interventions scheduled in advance succeeded. Total transradial technical success rate in the series was 95%. Frequency of complications such as radial injury or radial spasm was 1.8%. No cases of local hematoma, hand ischemia, or cerebral infarction were encountered. The transradial approach was useful for non-coronary angiography and interventions and offers the advantages of low risk and reduced stress on patients.

Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI Trial

Objective:To compare bleeding complications and results of percutaneous coronary intervention (PCI) between patients treated by radial and femoral approaches for acute myocardial infarction (AMI,) and using abciximab and 5 French...

Reverse Radial Forearm Fascial Flap with Radial Artery Preservation

The reverse radial forearm fascial (RRFF) flap is widely used in soft-tissue reconstruction of the hand. The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch. In patients with an abnormal Allen test because of an incomplete palmar arch, the traditional RRFF flap is contraindicated unless a vein graft is used to reconstruct the radial artery. A simpler alternative approach for hand reconstruction in such patients is a distally based RRFF flap based on radial artery perforators, which preserves the radial artery. We used RRFF flaps based on radial artery perforators in five patients who had palmar or dorsal soft-tissue loss. All five recovered full hand function, and only one had any complications (full-thickness skin graft loss at recipient site). The RRFF flap based on distal radial artery perforators is suitable for thin coverage of soft-tissue defects in hands with either a complete or an incomplete palmar arch.

The Role of Donor Site Angiography before Mandibular Reconstruction Utilizing Free Flap

This study was initiated to establish a treatment algorithm for preoperative evaluation of donor sites prior to the harvest of free osteocutaneous flaps, in the setting of complex mandibulofacial reconstruction. A total of 29 consecutive patients were treated between 1999 and 2003 in a university-based setting. Reconstructions were completed using either a free fibula osteocutaneous flap or a radial forearm free flap. Functional and aesthetic results were determined by completing a thorough patient physical examination postoperatively. We hypothesized that a routine preoperative angiogram at the donor site was unnecessary. The Allen's test was the only preoperative evaluation completed in the 13 patients undergoing the free radial forearm reconstruction. In the remaining 16 patients undergoing free fibula reconstruction, a thorough physical examination was completed, along with noninvasive Doppler examinations. No angiograms were obtained. Using this systematic approach, no ischemic complications were observed at the donor site. Only two complete flap losses were seen, one in each group, due to microvascular thrombosis. We conclude that preoperative assessment of the donor site(s) with only an Allen's test in the free radial forearm group and a thorough pulse exam and a noninvasive Doppler in the free fibula group appear adequate. Routine preoperative angiogram of the donor extremity may be unnecessary and place the patient at additional risk for associated complications.

Thromboangiitis Obliterans (Buerger Disease)

A healthy 44-year-old woman presented with a 1month history of diffuse arthralgias followed by skin discoloration of the fingers of both hands that progressed during a 1-week period and was accompanied by resting finger pain exacerbated by exposure to cold. She had a 25-pack-year history of cigarette smoking but no history of illicit drug use. Results of an Allen test were abnormal. Angiography revealed normal vessels interspersed with severe occlusive disease. Work-up with echocardiography and serologic testing for autoimmune antibodies, thrombophilia, and vasculitides, including anticentromere and anti-Scl-70 antibodies, yielded negative results. Thromboangiitis obliterans (Buerger disease) was diagnosed. Thromboangiitis obliterans is a nonatherosclerotic inflammatory disorder of unknown etiology that affects small and medium-sized vessels of the extremities and has a strong association with smoking. Angiographic findings may mimic those of conditions such as scleroderma (CREST syndrome) or prothrombotic disorders. Cessation of cigarette smoking is the only known effective therapy. This patient quit smoking and was treated with aspirin, dalteparin, and daily arterial flow pump therapy, which produced symptomatic improvement.

True ulnar artery aneurysm of the hand in an 18-month-old boy: A case report

True aneurysms of the hand arteries are rare and are exceedingly uncommon in children. Presented is a case of a true ulnar artery aneurysm in an 18-month-old boy in which there was no history of trauma. The aneurysm was resected without reconstruction because of the normal preoperative Allen test result, normal preoperative finger pressure measurement with ulnar artery occlusion, the angiographic evidence that the radial artery was the dominant artery of the hand, and intraoperative evidence of adequate hand perfusion after excluding the aneurysm from the hand circulation as documented by good Doppler signals in all digital arteries.

Palmar microcirculation does not deteriorate 2 years after radial artery harvesting—implications for reconstructive free forearm flap transfer

The functional consequences after radial artery-based forearm flaps for hand microcirculation remain unclear. We hypothesized that palmar microcirculation is compromised after radial artery removal in arteriosclerotic patients. A total number of 114 patients were included undergoing elective coronary revascularization using the radial artery of the nondominant forearm with non-pathological Allen's test. Palmar microcirculatory mapping with 1596 measurements was applied 2 years after removal of the radial artery regarding capillary flow, finger tip oxygenation, as well as postcapillary venous filling pressures throughout both hands using combined noninvasive real-time laser Doppler flowmetry and spectrophotometry. Only 2/56 positions revealed a difference beyond a 5% threshold 25 +/- 5 months after radial artery removal. Superficial capillary blood flow decreased by 13% at the hypothenar eminence (242.0 +/- 153.6 vs 275.6 +/- 169.2, p = 0.009). Deep postcapillary venous filling pressure (8 mm) was significantly increased by 9% only at the fingertip of the fifth finger (112.4 +/- 49.7 vs 103.0 +/- 25.0, p = 0.033). No clinical signs of malperfusion were found after radial artery removal, and no patient was impaired in his daily palmar motor activity. Pedicled removal of the radial artery does not compromise superficial or deep palmar capillary blood flow, finger tip oxygenation, or postcapillary venous filling pressures in a long-term perspective in arteriosclerotic patients. No clinical relevant signs of malperfusion or any deterioration of palmar motor function was encountered. The blood flow via the ulnar artery and the interosseal artery compensates palmar perfusion without microcirculatory deterioration even more than 2 years after removal of the radial artery.

Neurological Status and Tissue Perfusion Changes after Radial Artery Harvesting for Myocardial Revascularization: Importance of the Allen Test

Although radial artery (RA) removal for coronary revascularization is considered safe, there is still considerable suspicion concerning adequate hand perfusion. We investigated the blood flow alterations in the donor forearm by quantitative perfusion scintigraphy tests in patients with RA conduits, and compared the results between the patients using different Allen test refill lengths . 50 patients undergoing coronary artery bypass graft surgery with RA grafts were investigated. Perfusion studies and a detailed physical examination of the donor hand were performed preoperatively, and repeated early before the patient was discharged and six months after operation. Forearm perfusion scintigraphy was performed by 370 MBq Technetium-99m Methoxyisobutyl isonitrile (MIBI). Perfusion index (PI) and blood pool index (BPI) were calculated by dividing the computed data from obtained images of the donor side by that of the non-donor side. Comparisons of the indices were initially performed within all patients, then through dividing the patients into three groups according to their Allen test refill length using ANOVA. The incidence of any neurological symptoms was 32 % in the early postoperative period. Preoperative measurements of both PI and BPI in all patients were not statistically significant when compared with the values obtained from the postoperative course. Indices of patients with long Allen test refill lengths were significantly lower than those of other patients' data in the first week after surgery. No statistical difference was observed at six months after the operation. According to our results, removal of the RA for coronary revascularization is safe. Although a significant decline in hand perfusion was observed during the early postoperative period in patients with long Allen test refill, compensatory mechanisms provide a dramatic amelioration in digital blood flow leading to good functional and neurological outcomes in the late course.