Assessment and Management of Radial Artery Access

Current Evidence Against Routine Use

The American Heart Association states that performing Allen's or Barbeau test to confirm dual arterial circulation is "only of historical interest" 1
The RADAR trial found no evidence of hand ischemia in patients undergoing transradial access, even in those with abnormal Allen's test results 2, 1
An abnormal Allen's test should not preclude transradial access, according to the American College of Cardiology 3, 1
Patients should not be denied radial approach simply because of a "failed" Allen test, as recommended by the American Heart Association 1

Radial artery occlusion occurs in less than 5% of patients with current prevention strategies, as reported by the Journal of Neurointerventional Surgery 2, 3
When radial artery occlusion does occur, it is almost always clinically silent due to collateral circulation from the palmar arch via the ulnar artery, according to the American College of Cardiology 2, 1

Assessment of radial pulse remains important, but the Allen's test is not necessary, as stated by the American Heart Association 1
Ultrasound guidance is recommended as it increases speed and efficacy of transradial access, decreasing time to access and number of attempts while increasing first-attempt success rate, according to the Journal of Neurointerventional Surgery 2

Intraprocedural heparin administration (50 U/kg or 5000U) significantly reduces radial artery occlusion without increasing access site complications, as reported by the Journal of Neurointerventional Surgery 2, 3
Spasmolytic cocktail (calcium channel blocker with nitroglycerin) through sheath sideport reduces radial artery spasm from 15-30% to 6-10%, according to the Journal of Neurointerventional Surgery 2

Absent radial pulse is an absolute contraindication to transradial access, as stated by the American College of Cardiology 3
Functional arteriovenous fistula or planning for hemodialysis access is an absolute contraindication to transradial access, according to the American College of Cardiology 3

Complete arteriography from aortic arch to palmar arch is the most critical tool for diagnosing distal hypoperfusion, as recommended by the Journal of the American College of Radiology 4
Digital subtraction angiography performed with and without occlusion of the arteriovenous access can illustrate presence of steal phenomenon, according to the Journal of the American College of Radiology 4

The American Society of Anesthesiologists recommends assessing for radial pulse presence and using ultrasound to assess vessel patency and size, rather than Allen's test, to increase first-attempt success rates and decrease complications 5
The American College of Cardiology suggests identifying absolute contraindications, such as severe peripheral vascular disease, coagulopathy, local synthetic grafts, functional arteriovenous fistula, or planned hemodialysis access, before radial artery cannulation 5

The American Heart Association recommends using saline-heparin as the only safe solution for flushing arterial catheters 5