Variability of forearm collateral circulation: An observational study of serial hand plethysmography testing

Objectives: Evaluation of plethysmography as a reliable triage tool to access collateral circulation in the hand prior to transradial access. Background: Hand plethysmographic testing has been used for access site triage prior to cardiac catheterization despite a lack of data supporting its result's stability. Methods: Cohort of consecutive outpatients presenting for evaluation prior to cardiac catheterization underwent hand plethysmographic testing at the beginning of the office visit and before discharge. Demographics and clinical data was recorded. Results: Hands (N = 887) in 445 patients were evaluated using the Barbeau plethysmography technique. Barbeau Test (BT) patterns A, B, C, and D were observed in 58%, 30%, 8% and 4% on initial evaluation. On preliminary evaluation, 780 (88%) hands had a “low-risk” pattern (A or B) and 107 (12%) hands had a “high-risk” pattern (C or D). Repeat evaluation performed 50 ± 26 min later revealed a ‘low-risk’ pattern in 809 (91%) hands with 78 (9%) of hands showing a persistent “high risk” pattern. In 29 (27%) high-risk hands, spontaneous conversion to pattern B within <1 h occurred. Reverse Barbeau Test (RBT) at baseline showed pattern A, B, C and D in 95.9%, 2.8%, 1% and.4% respectively. There was no significant change in RBT upon follow-up evaluation. Strength of the radial artery pulsation was significantly associated with the pattern of RBT and the strength of ulnar pulsation was associated with the results of the BT. Conclusions: Plethysmographic testing of forearm circulation demonstrates variability over short intervals suggesting poor reliability for access site triage.