0:01

So let's progress with this limb

0:02

ischemia complication discussion.

0:04

It's a 59-year-old male presenting 24 hours

0:06

after coronary catheterization via right

0:09

radial artery access, and we have an

0:11

18-gauge needle that was used to achieve this.

0:13

The patient now has pain, numbness, and

0:15

coolness of the right hand and forearm.

0:17

So what are you suspicious of?

0:19

Common things being common, hand ischemia.

0:23

So we perform this sonographic evaluation of the

0:26

right forearm, and we are looking at sort of the

0:28

access here, and what do we see on the imaging?

0:34

Well, we have a color Doppler sort of box that

0:38

shows there's no flow in the radial artery, in

0:40

keeping with the thrombotic occlusion from the

0:43

level of the wrist to the antecubital fossa.

0:45

No bueno.

0:46

So diagnostic arteriography of the right forearm

0:48

is performed. What do you see on imaging?

0:50

Well, I think you see this.

0:53

Which is, there's brisk flow through

0:55

a widely patent ulnar artery.

0:57

There's no anterograde flow

0:58

through the radial artery.

0:59

And there's no retrograde flow noted

1:01

secondary to the dominance of the palmar arch.

1:05

So, let's conduct a little bit of

1:07

root cause analysis of this case.

1:09

So what was likely not performed?

1:12

You guessed it.

1:13

A pre-procedure Barbeau or modified Allen's

1:15

test was actually not performed in this setting.

1:19

So unfortunately, knowing is half of the battle.

1:24

Applying is the full story.

1:26

To know that a Barbeau test has to assess the

1:28

patency of the ulnar artery in the setting of

1:32

simulating radial artery thrombosis but

1:35

not doing it is missing the boat, unfortunately.

1:38

And that's what occurred in this setting.

1:41

So let's summarize.

1:42

Any condition that compromises collaterals to

1:45

the palmar arches can actually predispose a

1:47

patient to hand ischemia after radial artery

1:50

access, and it is important to identify before,

1:54

not after or during the procedure.

1:57

The Barbeau test should always be used

2:00

routinely as a point of standardized

2:02

practice to check the patency of the

2:04

ulnar artery to prevent limb ischemia as

2:06

a potential complication post-procedure.