Author + information
- Martin Brueck, MD⁎ ()
- ↵⁎Department of Cardiology, Clinic of Wetzlar, Forsthausstrasse 1, 35578 Wetzlar, Germany
We appreciate the interesting remarks of Dr. Pawlowski and colleagues regarding our report (1). We agree that the quality of the needle, guidewire, and sheath in radial artery cannulation is crucial. In particular, the wire should be both soft enough to cross any loops and stiff enough to straighten the vessel. The radial artery never forgets a failed puncture attempt, and therefore, the first radial attempt is the most important one.
The authors consider the Allen's test as clinically useless in everyday practice on the basis of reduced specificity. We excluded 347 of 2,316 screened patients from enrollment in the study, due to pathologic Allen's test. Data on patients undergoing transradial cardiac catheterization in spite of a pathologic Allen's test are not available to our knowledge, and such a study would be unethical and unjustifiable, especially under forensic aspects—thinking of the risk of losing just 1 hand. From the authors' view, as stated in the article, a transradial approach for cardiac catheterization should be avoided in the presence of an abnormal Allen's test unless the risk of using the transfemoral access is exceedingly increased.
Undoubtedly, the use of arterial puncture closure devices (APCD) generates more costs. In addition, ongoing data have raised concerns about the safety of APCD. A recent meta-analysis of 30 randomized trials has shown not only marginal evidence of effectiveness but also a possibly increased risk of hematoma and pseudoaneurysm (2). Due to these evolving data and the paucity of properly designed studies, the safety and efficacy of APCD must be pursued further. This meta-analysis highlights again the single greatest advantage of the radial approach—reduced vascular access complications.
- American College of Cardiology Foundation