Evaluation of collateral circulation of the hand

  title={Evaluation of collateral circulation of the hand},
  author={Thomas M. Fuhrman and William Pippin and Lance A. Talmage and Thomas E. Reilley},
  journal={Journal of Clinical Monitoring},
In 1929, Edgar V. Allen described a noninvasive evaluation of the patency of the arterial supply to the hand of patients with thromboangitis obliterans (Am J Med Sci 1929;178:237). In the early 1950s, Allen's test was modified (Wright I. Vascular diseases in clinical practice. Chicago: Year Book Medical Publishers, 1952) for use as a test of collateral circulation prior to arterial cannulation. This test involves the examiner occluding the patient's ulnar and radial arteries while the patient… 
Modified Allen’s test performed with a pulse oximeter – back to the future?
  • N. Eipe
  • Medicine
    Acta anaesthesiologica Scandinavica
  • 2007
A 38-year-old right-handed man underwent inguinal hernioplasty under epidural anesthesia and a negative modified Allen’s test suggested an inadequate ulnar collateral circulation.
The results suggest that a positive Al- len's test can be found in both left and right-handed people, with regard to the left andright hands and both radial and ulnar arteries may be implicated.
Assessment of collateral circulation to the hand prior to radial artery harvest
The anatomy and the physiologic basis for the MAT, the pros and cons of various NITs, and recommendations for the assessment of collateral circulation to the hand prior to interventions directed at the RA are reviewed.
Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations
Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts, and research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation.
Combining the Modified Allen’s Test and Pulse Oximetry for Evaluating Ulnar Collateral Circulation to the Hand for Radial Artery Catheterization of the ED Patient
How pulse oximetry may be used to perform the modified Allen’s test in patients to evaluate collateral circulation and potentially reduce the risk of iatrogenic hand ischemia is discussed.
Hand Perfusion in Patients with Physiological or Pathological Allen's Tests
Patients with a pathological AT suffered significantly more from the loss of dual hand perfusion than patients with a physiological AT and need more time to compensate for the altered perfusion pattern.
The modified Allen test and a novel objective screening algorithm for hand collateral circulation using differential photoplethysmography for preoperative assessment: a pilot study
The proposed procedure/algorithm may provide many indicators of the hand blood circulation, the effect of an artery occlusion on the hand, and a recommendation for selecting the best artery to access with the lowest possible complications.


Clinical Evaluation of Blood Flow to the Hand: The False‐Positive Allen Test
The authors recommend that the Allen test be performed with the patient's hand slightly flexed and relaxed, and no individual artery required more than 6 seconds for the flush to appear after opening of the hand.
Evaluation of the palmar circulation by pulse oximetry
Using the photoplethysmographic component of the pulse oximeter may improve the assessment of collateral circulation of the hand in which arterial cannulation is being contemplated.
Thrombosis following percutaneous radial artery cannulation
The incidence of thrombosis was not correlated to sex, age, size of artery (judged by wrist circumference), cannulation technique or the presence of hypotension, but it did, however, correlate to the existence of haematoma at the puncture site.
Severe ischemia of the hand following radial artery catheterization.
Percutaneous radial artery catheterization for blood gas monitoring and continuous arterial pressure recording has become a common place procedure in the management of critically ill patients and review of the events preceding and during cannulation allowed elucidation of the following principles.
Allen's test performed by pulse oximeter
It is suggested that it is more helpful to look at the question from the standpoint of pathology rather than anatomy, to consider what goes into the space, a t what level and for how long, and the condition of the intervening tissues.
Physiologic anatomy of the palmar circulation in 200 normal hands.
The functional capacity of the Superficial Palmar Arch (SPA) was evaluated in 200 normal hands by a non-invasive narrow beam ultrasonic technique and the use of tobacco does not increase the incidence of incomplete SPAs.
Complications of Percutaneous Radial-artery Cannulation: An Objective Prospective Study in Man
One hundred and five percutaneous radial-artery cunnulations were prospectively studied in 100 patients, with a high incidence of temporary thrombosis, and radial arterial pulses produced by retrograde ulnar-arterY flow were palpable distal to 73 per cent of the radialartery thrombi.
Radial artery cannulation and ishaemic damage: a review
A review of the literature concerning ischaemic complications following radial artery cannulation suggests that the Allen test has little predictive validity. Other methods of assessing the ulnar
Photo-electric plethysmography as a monitoring device in anaesthesia. Application and interpretation.
Physiologically, changes in blood volume pulsations depend on the distensibility of the vessel wall as well as on the intravascular pulse pressure, and it is shown that changes in the height of ventilatory waves may be of diagnostic significance.