Transradial access without preliminary allen test—letter of comment on Rhyne et al.

Radial artery spasm associated with transradial cardiovascular procedures: Results from the RAS registry

“…In our study, the operators did any form of collateral testing such as Allen's test in less than half of the cases, which is likely a manifestation of the current debate regarding the role of testing prior to a TRA procedure . In fact, many operators typically perform TRA procedures without the assessment of the dual hand circulation with excellent safety outcomes . Furthermore, only a few cases of severe hand ischemia have been published so far out of large number of TRA procedures perform throughout the world without testing .…”

Right versus left radial artery access for coronary procedures: An international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients

“…Indeed, it is conceivable that most operators involved in the included studies were highly experienced and thus at an overall low risk of radial failure. Whereas our personal preference goes almost invariably to right radial or ulnar access, mainly because of greater operator comfort [6,7], [19], we can thus suggest radial beginners to systematically adopt left radial access until they reach a substantial expertise in transradial procedures. Once their learning curve is complete and their transradial skills refined, both right and left radial accesses can be used.…”

“…Most procedures were diagnostic coronary angiographies, with PCI performed during the same procedure in 32.5% of patients. Notably, subjects were enrolled only after proof of a normal Allen test, despite recent suggestions that this may not be mandatory in clinical practice [18,19].…”

“…However, they would not be likely to substantially change the main findings of our review. Nonetheless, further issues worth researching include the appraisal of a total wrist access strategy (attempting both ipsilateral radial and ulnar accesses before moving to the contralateral radial or ulnar arteries) [19]. Whereas fluoroscopy time is easily collected, it has a very limited usefulness to estimate radiation exposure.…”

“…Indeed, no data on operator experience/ volume could be extracted from the included studies, and thus formal analysis of this important aspect was beyond the scope of our work. Nonetheless, we can safely state, based on both personal extensive experience in radial access and medical literature [3,19], that left radial access can be considered more suitable to operators already trained in femoral access but with experience in radial procedures, mainly because left radial access entails more favorable catheter geometry than right radial access. Finally, the apparent mismatch between the higher cross-over rate to femoral access with right radial access and procedural duration, contrast administration and fluoroscopy time might be explained by several factors.…”