Background: The feasibility of  using  modified  Allen’s tests  and  Doppler ultrasonography to evaluate arterial circulation and diameters in the forearm arteries for transradial coronary angiography, and the correlation of these tests with the complications were examined.

Material & Methods: This was an observational study and the hand circulation of 70 patients scheduled for transradial coronary angiography was assessed by Modified Allen’s test and Doppler ultrasonography.  Findings of the positive modified Allen’s test and diameter of the radial, ulnar arteries were recorded and compared for the various demographic, risk factors profile, vascular access complications and procedural outcomes.

Results: A total of 70 patients were evaluated and 16 had a positive modified Allen’s test. The mean diameter of right and left radial artery was 2.5±0.4mm and 2.4±0.4mm respectively (p=0.470). The mean diameter of right and left ulnar artery was 2.7±0.4mm and 2.7±0.4mm respectively (p=0.782). Highly significant difference was found between the respondents (p<0.001) when forearm arteries was compared to each other. There was no relationship of the size of the radialandulnar artery with age, body Mass Index (BMI) and various risk factors studied. However, the diameter of the forearm arteries showed good correlation with each other. Significant correlation was found between arterial spasm (p<0.001) and crossover (p=0.010) & modified Allen’s test. Statistically significant correlation was found between Doppler measured right radial artery diameter and arterial spasm (p=0.001). The positive Modified Allen’s test and Doppler measured Forearm artery diameters when correlated, then statistically significant difference was found suggestive of smaller diameters were found in patient with a positive Modified Allen’s test.

Conclusions: Use  of  Modified  Allen’s  test  as  a  screening  tool  to  assess  the collateral circulation of hand correlates well with the occurrence of complication and there has been a significant correlation between the positive Modified Allen’s test and Doppler measured radial artery diameter and the occurrence of complications in our study. A positive modified Allen’s test completely obviates the need for Doppler assessment and provides no additional benefit rather we exercise caution and change the access site if possible.

Keywords: Allen’s Test, Modified Allen’s Test, Radial Artery Diameter, Transradial Coronary Angiography.

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Adeel Majeed Belim

Consultant Cardiologist, Fortis Balaji Hospital, Jodhpur, India