This paper was presented in the just concluded 60th Annual scientific sessions of cardiological society of India , Chennai.India
POSITIVE ALLEN’S TEST FOLLOWING RADIAL CORONARY ANGIOGRAM
Venkatesan sangareddi , G.Gnanavelu, R.Alagesan,V.Jaganathan.
Department of cardiology, Madras Medical College, Chennai.
Radial artery has become the major access site for the interventional cardiologist in recent years. Radial approach has provided increased patient comfort and less access site complication. Many of the complications are unique to radial approach mostly due to anomalies of origin, and course while others are hardware related .Unlike femoral arterial access , compromise of blood supply to hand is never considered a threat because of dual blood supply to hand .But the fact is that, it could be sub-clinical and the hand is rarely assessed for vascular insufficiency after a radial procedure.
The aim of the study is to assess the impact of radial procedures on the blood flow to hand . 20 patients who had undergone routine radial coronary angiogram formed the study population. All patients had negative Allen’s test prior to the procedure. The mean procedure time was 25mts (18-45) .Standard hardwares were used. Difficulty in crossing at forearm and subclavian was observed in 4 patients. Extravasation of dye in forearm was observed in two. Allen test was done 24 hours after sheath removal and repeated 48 hours after the procedure . 4 patients showed positive Allen test at 24hrs. One patient regained Allen negativity at 48hours. The incidence of positive Allen test at 24 hours is 20%. The compromised blood flow was correlated with the procedure time, and a difficult catheter course .
We propose, radial procedures especially , when prolonged has a potential to compromise palmar arch flow .This phenomenon is either permanent or transient and may be attributable to enhanced endothelial tone and sheath related injury. Irreversible compromise of blood flow to palmar arch may also occur in radial dominant hands. Further enhanced sympathetic tone can spill over to ulnar artery as well .
It is concluded, interventions through radial route has hitherto unreported adverse effect of “Post procedural positive Allen test” . It implies , radial procedures could convert a dual blood supply pattern of the hand to ulnar dependent uni-modal blood flow in a significant subset of patients. This is important to recognise, as it precludes further radial procedures in the same patient.
Final message
Hand function could be as vital as our heart’s , please handle with care to avoid this complication
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Dr.S.Venkatesan MD 