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Koutouzis M - AIMRADIAL 2015 - Transradial and negative Allen test


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Transradial approach for cardiac catheterization in patients with negative Allen’s test

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Koutouzis M - AIMRADIAL 2015 - Transradial and negative Allen test

  1. 1. Transradial approach for cardiac catheterization in patients with negative Allen’s test J INVASIVE CARDIOL 2015;27(9):416-420 Michael Koutouzis, MD, PhD, FESC Interventional Cardiologist 2nd Cardiology Department Hellenic Red Cross Hospital of Athens, Greece
  2. 2. • The major complication of the transradial catheterization is radial artery occlusion, which can be permanent and is reported between 1% - 10% in different studies • Allen’s test is a relatively easy way to document double artery perfusion of the hand, excluding the risk of hand ischemia in case of radial artery occlusion • In many high volume radial centers the Allen’s test is no longer used and its usefulness is questioned. Background
  3. 3. Allen’s test
  4. 4. Real World Practice • An international transradial practice survey found that 58% of operators used modified AT and 16% used Barbeau’s test, whereas 23% of operators did not perform any test prior to performing TRA-PCI Bertrand OF, Rao SV, Pancholy S, et al. Transradial approach for coronary angiography and interventions: results of the first international transradial practice survey. JACC Cardiovasc Interv.2010;3:1022-1031
  5. 5. Cohort Study • 1035 procedures were performed via radial approach. • 588 procedures (56.8%) were coronary angiography only, • 447 (43.2%) underwent coronary angiography plus ad hoc angioplasty • Allen’s test was performed before the procedure, with the results remaining unknown to the operators in order to reduce bias • If pulse was not identified before discharge, a doppler examination was performed
  6. 6. Results Baseline characteristics
  7. 7. Indications
  8. 8. Procedural characteristics
  9. 9. Procedural characteristics in angioplasty
  10. 10. Complications
  11. 11. Radial Artery Thrombosis • Radial artery thrombosis was observed in 6.2% of the negative Allen’s test group and 4.8% of the positive Allen’s test group (P=.85), but was clinically silent in both groups.
  12. 12. Predictors for preventing Radial Occlusion regardless of the Allen’s test results • Diameter of the sheath and its relation to the size of the radial artery • the post-procedural compression time • the presence of anterograde flow in the artery during hemostasis • the use of anticoagulation Yoo BS. Int J Cardiol. 2005;101:421-427 Nagai S, et al. Am J Cardiol. 1999;83:180-186 Pancholy SB. J Invasive Cardiol. 2009;21:101-104 Sanmartin, et al. Catheter Cardiovasc Interv. 2007;70:185-189
  13. 13. What the literatures say • plethysmography and pulse oximetry improve the sensitivity of the modified Allen’s test. • Observations from the congenital heart disease and vascular surgery spheres lead us to conclude that Allen’s Test is a misleading and inaccurate test of collateral blood supply to the hand. • There may be no role for Allen’s testing to determine the suitability of a patient for transradial procedures Barbeau GR et al. Am Heart J. 2004;147:489-493 Shah A et. al. J INVASIVE CARDIOL 2015;27(5):E70-E73 Ian C. Gilchrist, MD and Sunil V. Rao, MD . J INVASIVE CARDIOL 2015;27(5)
  14. 14. Conclusions The transradial approach for coronary angiography and ad hoc angioplasty can be performed with : •similar efficacy •fewer local complications •faster patient ambulation •greater patient satisfaction Regardless of the preprocedural Allen’s test results
  15. 15. Thank you…