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J Thorac Cardiovasc Surg 2001;121:526-531
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Preoperative assessment of hand circulation by means of Doppler ultrasonography and the modified Allen test

From the Department of Cardiac Surgery,^a the Department of Radiology,^b the Department of Cardiology,^c Austin & Repatriation Medical Centre, and the Department of Mathematics and Statistics,^d the University of Melbourne, Victoria, Australia.

Received for publication Aug 23, 2000. Revisions requested Sept 7, 2000; revisions received Oct 13, 2000. Accepted for publication Oct 20, 2000. Address for reprints: Brian F. Buxton, MS, FRACS, Department of Cardiac Surgery, Austin Campus, HSB-5, Austin & Repatriation Medical Centre, Studley Rd, Heidelberg, Victoria 3084, Australia (E-mail: bux{at}austin.unimelb.edu.au).

Objective: The aims of this study were as follows: (1) to evaluate Doppler ultrasonography in assessing hand collateral circulation; (2) to define the criteria for an abnormal Doppler ultrasonography dynamic test result; and (3) to validate the modified Allen test.
Methods: The hand circulation of 71 patients scheduled for coronary artery bypass grafting was assessed by means of the Allen test and Doppler ultrasonography. The flow in the superficial palmar branch of the radial artery, the ulnar artery, and the dorsal digital thumb artery with and without radial artery compression were recorded. Flow patterns in the superficial palmar branch of the radial artery, the ulnar artery, and the dorsal digital thumb artery with radial artery compression were categorized into 4 groups: (1) no flow; (2) decreased flow; (3) reversed flow; and (4) increased flow.
Results: Among the 71 hands, 4 (5.6%) had an abnormal Allen test result (>10 seconds). Seven (10.6%) of 66 superficial palmar branches of the radial artery, 3 (4.2%) of 71 ulnar arteries, and 2 (2.8%) of 71 dorsal digital thumb arteries showed no flow with radial artery compression, as measured by Doppler ultrasonography. There were significant differences among the 4 groups (superficial palmar branch of the radial artery: F = 7.0, P < .001; ulnar artery: F = 13.1, P < .001; and dorsal digital thumb artery: F = 8.4, P < .001) for the Allen test. Pairwise comparisons showed that when subjected to an Allen test, category 1 patients (no flow) had significantly longer recovery times compared with the other groups (P < .02 in all cases) for the superficial palmar branch of the radial artery, the ulnar artery, and the dorsal digital thumb artery.
Conclusion: Absence of flow in the dorsal digital thumb artery with radial artery compression is considered an absolute contraindication to radial artery harvesting. An increased recovery time with the modified Allen test predicts absence of flow in the dorsal digital thumb artery in Doppler ultrasonographic flow patterns. This demonstrates the validity of the modified Allen test for primary screening.

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