Abstract
This prospective double-blind study compared Doppler assessment of the ulnar collateral circulation with the Allen’s test and a postocclusive réactive circulatory hyperaemia (PORCH) test in 144 patients (288 hands). The PORCH test involves inflation of a blood pressure cuff on the upper arm to a supra systolic (+50 mmHg) pressure for two minutes. Prior to cuff deflation, both radial and ulnar arteries are occluded at the wrist; the cuff is then deflated and a 15-second period allowed so as to restore blood flow down to the wrist. Ulnar artery compression is now released and the time to revascularization measured. Fifty-eight per cent of hands with an abnormal Allen’s test had a normal ulnar collateral circulation. Results of Allen’s test were not significantly affected by patients’ sex or smoking status (p > 0.1) but there was a significant difference (p = 0.001) in the false positive rates between patients over 40 years of age (0.2) and those under 40 years of age (0.03). Results of the PORCH test were not significantly affected by patients’ age, sex or smoking status (p > 0.1). With a revascularisation time of 19 sec as a “cut off” for ulnar abnormality the PORCH test, unlike the Allen’s test, was perfectly predictive of an abnormal ulnar collateral circulation and had no false positives.
Résumé
Celte étude prospective à double insu compare ľévaluation au Doppler de la circulation cubitale avec le test ďAllen et le test de (PORCH) ďhyperémie réactive postocclusive chez 144 patients (288 mains). Le test de PORCH implique ľinflation du sphymomanomètre appliqué sur le bras à une pression supra svstolique (+ 50 mmHg) pour deux minutes. Avant le dégonflement du sphygmomanomètre les artères radiale et cubitale sont occluses au niveau du poignet. Le brassard est par la suite dégonflé et ľon attend 15 secondes afin de permettre la restauration du flot sanguin au poignet. La compression de ľartère cubitale est maintenant relâchée et le temps de revascularisation mesuré. Cinquante-huit pour cent des mains avant présenté un test ďAllen anormal avaient une circulation collatérale cubitale normale. Les résultats des tests ďAllen n’étaient pas significativement affectés par le sexe des patients ou le tabagisme (p > 0.1) mais il y avait une différence significative (p = 0.001) avecles taux de test faussement positifs entre les patients âgés de plus que 40 ans (0.2) et ceux âgés de moins que 40 ans (0.03). Les résultats des tests de PORCH n’étaient pas signiflcativement affectés par ľâge des patients, leur sexe ou leur tabagisme (p > 0.1). Avec un temps de revascularisation de 19 secondes pris comme point de repère pour une anomalie dans la circulation collatérale, le test de PORCH, contrairement au test ďAllen, pouvait prédire parfaitement une circulation collatérale cubitale anormale et ne présentait pas de faux positifs.
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Vaghadia, H., Schechter, M.T., Sheps, S.B. et al. Evaluation of a postocclusive reactive circulatory hyperaemia (PORCH) test for the assessment of ulnar collateral circulation. Can J Anaesth 35, 591–598 (1988). https://doi.org/10.1007/BF03020346
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DOI: https://doi.org/10.1007/BF03020346