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

Evaluation of plethysmography as a reliable triage tool to access collateral circulation in the hand prior to transradial access. Hand plethysmographic testing has been used for access site triage prior to cardiac catheterization despite a lack of data supporting its result's stability. 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. 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 25% of patients initial showing higher risk for ischemia patterns were low risk on reexamination.•Barbeau Testing appears to give unstable results over