Maarten A H van Leeuwen1, Maurits R Hollander1, Dirk J van der Heijden1, Peter M van de Ven1, Kim H M Opmeer1, Yannick J H J Taverne1, Marco J P F Ritt1, Ferdinand Kiemeneij1, Nicolas M van Mieghem1, Niels van Royen2. 1. From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.). 2. From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.). niels.vanroyen@radboudumc.nl.
Abstract
BACKGROUND: The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown. METHODS AND RESULTS: The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77). CONCLUSIONS: Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization.
BACKGROUND: The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown. METHODS AND RESULTS: The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77). CONCLUSIONS: Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization.
Authors: Thomas A Meijers; Adel Aminian; Marleen van Wely; Koen Teeuwen; Thomas Schmitz; Maurits T Dirksen; Sudhir Rathore; René J van der Schaaf; Paul Knaapen; Joseph Dens; Juan F Iglesias; Pierfrancesco Agostoni; Vincent Roolvink; Miguel E Lemmert; Renicus S Hermanides; Niels van Royen; Maarten A H van Leeuwen Journal: J Am Heart Assoc Date: 2022-01-13 Impact factor: 6.106
Authors: Renato Francesco Maria Scalise; Armando Mariano Salito; Alberto Polimeni; Victoria Garcia-Ruiz; Vittorio Virga; Pierpaolo Frigione; Giuseppe Andò; Carlo Tumscitz; Francesco Costa Journal: J Clin Med Date: 2019-10-18 Impact factor: 4.241
Authors: Paige K Dekker; Niki Noe; Jenna C Bekeny; Christopher Lavin; Elizabeth G Zolper; David H Song; Kenneth L Fan Journal: Plast Reconstr Surg Glob Open Date: 2021-01-21
Authors: Karen A García-Rueda; César H Cediel-Barrera; Maribel Plaza-Tenorio; John U Cataño-Bedoya; Juan C Ortiz-Uribe; Keyner Toro-Osorio; Mailyn Peña-Pineda; Juan M Senior-Sánchez Journal: Arch Cardiol Mex Date: 2022-04-04
Authors: Hesham R Alokaili; Tanveer A Bhat; Tareg M Alhablany; Tuqa A Alsinan; Duaa N Almansour; Felwa A AlMarshad; Abdulla Altamimi; Mohamed Ouhlous; Jawad Alnaqaa Journal: Cureus Date: 2022-08-27
Authors: Thomas A Meijers; Adel Aminian; Koen Teeuwen; Marleen van Wely; Thomas Schmitz; Maurits T Dirksen; Rene J van der Schaaf; Juan F Iglesias; Pierfrancesco Agostoni; Joseph Dens; Paul Knaapen; Sudhir Rathore; Jan Paul Ottervanger; Jan-Henk E Dambrink; Vincent Roolvink; A T Marcel Gosselink; Renicus S Hermanides; Niels van Royen; Maarten A H van Leeuwen Journal: BMJ Open Date: 2020-07-20 Impact factor: 2.692