Vascular Complications Following Transradial and Transulnar Coronary Angiography in 1600 Consecutive Patients

Background: Major, noncoronary complications are rarely encountered following transradial coronary procedures. Methods and Results: Among 1600 prospectively studied patients with complete follow-up, 7 patients experienced major complications following coronary forearm procedures corresponding to an incidence of 0.44%. We found inadvertent symptomatic intramyocardial contrast medium injection, 2 cases with compartment syndrome of which 1 was managed surgically, exertional hand ischemia due to radial artery occlusion, a large ulnar artery pseudoaneurysm, an ulnar arteriovenous fistula, and 1 critical hand ischemia due to late occlusion of the distal brachial artery. Conclusions: Although infrequent, surveillance for major complications should be encouraged after forearm coronary procedures.

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A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

Journal of Interventional Cardiology ◽

10.1155/2020/7928961 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Dmitrii V. Ognerubov ◽

Alexander Sedaghat ◽

Sergey I. Provatorov ◽

Andrey S. Tereshchenko ◽

Olivier F. Bertrand ◽

...

Keyword(s):

Coronary Angiography ◽

Randomized Trial ◽

Hospital Discharge ◽

Radial Artery ◽

Ulnar Artery ◽

Artery Occlusion ◽

Puncture Site ◽

Coronary Procedures ◽

Baseline Characteristics ◽

Radial Artery Occlusion

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

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Impact of the Use of a Larger Forearm Artery on the Efficacy and Safety of Transradial and Transulnar Access: A Randomized Trial with Preprocedural Ultrasonography

Journal of Clinical Medicine ◽

10.3390/jcm9113607 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3607

Author(s):

Pawel Lewandowski ◽

Anna Zuk ◽

Tomasz Slomski ◽

Pawel Maciejewski ◽

Bogumil Ramotowski ◽

...

Keyword(s):

Randomized Trial ◽

Vascular Complications ◽

Ulnar Artery ◽

Coronary Intervention ◽

Artery Occlusion ◽

Percutaneous Coronary ◽

Secondary Endpoints ◽

The Impact ◽

Selection Of

(1) Background: We aimed to assess the impact of the selection of a larger radial or ulnar artery on the efficacy of access and vascular complications, based on preprocedural ultrasonographic examination. (2) Methods: This prospective, randomized trial included patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Patients were randomized into either a larger ulnar artery (UA) or radial artery (RA) group or smaller UA/RA group. The primary endpoint was successful CAG/PCI without crossover to another artery. The secondary endpoints were incidences of radial or ulnar artery occlusion (RAO/UAO) at the 24 h and 30 day follow-up. (3) Results: Between 2017 and 2018, 200 patients (107 men, mean age 68 ± 8 years) were enrolled. The success of CAG/PCI via the access site was 98% and 83% (p < 0.001) in the larger UA/RA group and smaller UA/RA group, respectively. The independent factor for CAG/PCI success was the larger artery (OR 9.8, 95%CI 2.11–45.5; p < 0.005). The larger UA/RA was superior, with RAO/UAO at 24 h: OR 0.07, 95%CI 0.09–0.61; p < 0.016; and RAO/UAO at 30 days: OR 0.25, 95%CI 0.05–0.12; p < 0.001. (4) Conclusions: Larger artery access was shown to be more efficient and safer than recessive forearm artery access.

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Is radial artery occlusion and local vascular complications following transradial coronary procedures affected by the type of haemostasis device used? A non-inferiority Randomized Controlled Trial (RadCom trial)

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab004 ◽

2021 ◽

Author(s):

Nicole Due-Tønnessen ◽

Cecile H Egeland ◽

Oliver J Meyerdierks ◽

Anders Opdahl

Keyword(s):

Radial Artery ◽

Controlled Trial ◽

Vascular Complications ◽

Artery Occlusion ◽

Radial Compression ◽

Complication Rates ◽

Access Site ◽

Randomized Controlled ◽

Coronary Procedures ◽

Radial Artery Occlusion

Abstract Aims Vascular access site complications following transradial coronary procedures are less common and severe compared to femoral approach. Radial artery occlusion is considered the main adverse effect. As radial access is gaining more acknowledgement, complication awareness, and understanding is important. The aim was to assess complication rates following transradial coronary procedures and to compare two radial compression devices in a non-inferiority randomized controlled trial. Methods and results Four hundred and ninety-nine patients were randomized to radial compression with a new device (RY Stop, n = 248) or the reference device (TR Band, n = 251) following transradial coronary procedures. Radial artery occlusion persistent at 90 days was the primary endpoint. Discomfort and accounts of vascular complications at access site were secondary endpoints. Radial artery occlusion was observed in 5% (n = 26) for the entire cohort with no difference between groups (RY Stop 6% vs. TR Band 5%; P = 0.69). Patients overall reported low levels of discomfort and the median scores were similar in both groups; RY Stop: 7 vs. TR Band: 10 (P = 0.90). There were few incidents of bleeding (7%), however, they were significantly more frequent with the RY Stop (12%) than with the TR Band (3%; P = 0.001). Few patients (4%) developed access site haematomas, and the incidence was similar in the two groups (P = 0.98). Conclusion We observed a radial artery occlusion rate of 5% at 90 days post-procedure. Access site discomfort and vascular complication rates were low. Overall, the RY Stop compression device was not inferior to the TR Band except occurrences of bleeding.

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Routine snuffbox approach do not reduce radial artery occlusion in comparison with conventional transradial access

European Heart Journal ◽

10.1093/eurheartj/ehab724.2129 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

L Kozinski ◽

A Dabrowska-Kugacka ◽

Z Orzalkiewicz

Keyword(s):

Radial Artery ◽

Hemodynamic Instability ◽

Artery Occlusion ◽

Similar Frequency ◽

Funding Sources ◽

Transradial Access ◽

St Elevation ◽

Coronary Procedures ◽

Radial Artery Occlusion

Abstract Background/Introduction Postprocedural radial artery occlusion (RAO) is still the Achilles' heel of conventional transradial approach (cTRA) as it limits its reuse for future coronary procedures. A distal transradial access (dTRA) via the anatomical snuffbox has been proposed as an alternative. It is hypothesised that dTRA may reduce the incidence of RAO. Purpose To assess whether routine dTRA reduce the risk of RAO in consecutive patients undergoing coronary angiography or intervention, in comparison with cTRA. Methods Out of 465 subjects, 400 patients were included in a prospective, single-center, randomized (1:1) study. Hemodynamic instability, ST-elevation myocardial infarction, forearm artery occlusion or prior radial access failure were the exclusion criteria. Ultrasound-guided follow-up was obtained after 1 day and 60 days to evaluate the incidence of acute and late RAO. Results Baseline characteristics of patients were matched. Results are presented in table 1. Conclusion(s) The incidence of postprocedural acute and late RAO after routine dTRA and cTRA is low and occur with similar frequency when evaluated by ultrasound. FUNDunding Acknowledgement Type of funding sources: None. Table 1

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Vascular Complications of Transradial Access for Cardiac Catheterization

US Cardiology Review ◽

10.15420/usc.2020.23 ◽

2021 ◽

Vol 15 ◽

Author(s):

Tanawan Riangwiwat ◽

James C Blankenship

Keyword(s):

Radial Artery ◽

Cardiac Catheterization ◽

Rare Complication ◽

Vascular Complications ◽

Daily Practice ◽

Artery Occlusion ◽

Prompt Treatment ◽

Hand Ischemia ◽

Transradial Access ◽

Radial Artery Occlusion

Transradial access has been increasingly adopted for cardiac catheterization. It is crucial for operators to recognize potential vascular complications associated with radial artery access. Prevention, early detection, and prompt treatment of vascular complications are essential to prevent serious morbidities. This review aims to raise awareness of transradial access vascular complications. Radial artery spasm is treated with intra-arterial verapamil and/or nitroglycerine. Hemorrhagic complications, such as perforation, hematoma, arteriovenous fistula, and pseudoaneurysm, are treated with prolonged compression. Patent hemostasis and adequate anticoagulation are used to prevent radial artery occlusion. Hand ischemia is a rare complication not associated with abnormal results of the Allen or Barbeau test, and can be treated with intra-arterial verapamil, IV heparin, and IV diltiazem. Finally, an attentive monitoring protocol for the timely detection of vascular complications should be implemented in daily practice.

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Comparison of transradial coronary intervention for left main bifurcation disease using the new Braidin® slender 7 Fr sheath and a standard 6 Fr sheath

Journal of International Medical Research ◽

10.1177/0300060520954727 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052095472

Author(s):

Yingkai Xu ◽

Yingkai Li ◽

Jiancai Yu ◽

Deguang Wang ◽

Qi Zhao ◽

...

Keyword(s):

Radial Artery ◽

Multivariate Logistic Regression Analysis ◽

Operation Time ◽

Coronary Intervention ◽

Artery Occlusion ◽

Left Main ◽

Percutaneous Coronary ◽

Occlusion Rate ◽

Radial Artery Occlusion

Objectives To compare the effectiveness and safety of the Braidin® slender 7 Fr sheath with a standard 6 Fr sheath for treating left main bifurcation disease. Methods From January 2017 to March 2019, 277 patients with left main bifurcation disease who underwent the transradial approach for percutaneous coronary intervention were divided into the slender 7 Fr sheath group (Braidin® slender 7 Fr sheath, n = 154) and standard 6 Fr sheath group (n = 123). Pathological features, surgical effect, and complications were evaluated. Results The rate of using the classic crush technique was significantly higher in the slender 7 Fr sheath group than in the standard 6 Fr sheath group. The slender 7 Fr sheath group had a significantly shorter operation time than the standard 6 Fr sheath group. There were no significant differences in the radial artery occlusion rate after surgery and at 1 month of follow-up between the groups. Multivariate logistic regression analysis showed that 6 Fr and Braidin slender 7 Fr sheaths did not predict radial artery occlusion. Conclusion The Braidin slender 7 Fr sheath has a superior operative process and similar safety for the radial artery as that of the standard 6 Fr sheath for treating left main bifurcation disease.

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Metode Barbeau Test dalam Menilai Keutuhan Arteri Radialis Pascaintervensi Koroner Perkutan

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v2i1.82 ◽

1970 ◽

Vol 2 (1) ◽

Author(s):

Nurhusna N ◽

F Sri Susilaningsih ◽

Purwo Suwigjo

Keyword(s):

Radial Artery ◽

Cardiac Catheterization ◽

Quantitative Research ◽

Clinical Observation ◽

Vascular Complications ◽

Artery Occlusion ◽

Vascular Complication ◽

Test Method ◽

Significant Difference ◽

Radial Artery Occlusion

Radial artery occlusion merupakan salah satu komplikasi vaskular postkateterisasi jantung trans radial. Kompresi lokal menggunakan alat kompresi setelah tindakan kateterisasi jantung trans radial dapat menurunkan angka kejadian komplikasi vaskular Radial Artery Occlusion(RAO). Penelitian ini bertujuan untuk mengetahui perbandingan antara metode Barbeau test dan metode pengamatan klinik dalam menilai keutuhan arteri radialis selama proses kompresi pada pasien postprosedur kateterisasi jantung trans radial. Penelitian ini merupakan penelitian kuantitatif dengan desain studi komparatif. Subjek penelitian adalah 20 pasien yang menjalani prosedur kateterisasi jantung dengan akses arteri radialis. Pengukuran dilakukan secara bertahap menit ke-15 dan setelah tiga jam menggunakan alat kompresi stepty-p. Uji komparasi menggunakan uji McNemar. Data univariat dianalisis menggunakan distribusi frekuensi. Hasil uji statistik menunjukkan ada perbedaan penilaian keutuhan arteri radialis antara metode Barbeau testdengan metode pengamatan klinik pada menit ke-15 (p=0.035) dan ke-30 (p=0.035). Namun secara keseluruhan hasil uji statistik menunjukkan tidak ada perbedaan yang bermakna dalam menilai kepatenan arteri pada setiap waktu pengamatan dari kedua metode. Kata kunci:Arteri radialis, Barbeau test, kateterisasi jantung, keutuhan, pengamatan klinik AbstractRadial artery occlusion is one of the trans radial vascular complications post cardiac catheterization. The local compression using compression methods after cardiac catheterization can be reduced the vascular complication such as radial artery occlusion (RAO). This research was conducted to determine the comparison between the Barbeau test method and the clinical observation method carried out by the researcher in order to examine the patency of radial artery during compression, post procedure cardiac catheterization at the Angiography Coroner Unit and the Cardiac Intensive Care Unit, Hasan Sadikin Bandung General Hospital, Indonesia. This research was a quantitative research using the comparative study design. The subjects were 20 patients who took cardiac catheterization procedure using radial artery access and checked in pairs. The measurement divided into two periods: the fifteenth minute and the third hour using the stepty-p compression tool. The statistical test used the McNemar test to analyze the comparison, and the single variable data were analyzed using the distribution frequency. There were a significant difference in radial artery evaluation during compression period between two methods, in which at the first fifteen minutes (p=0.035) and the first thirty minutes (p=0.035), respectively. Overall, the result shows that there were no significant difference in comparison of two methods. Key words:Barbeau test, cardiac catheterization, clinical observation, patency, radial artery

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The frequency of radial artery occlusion following cardiac catheterization with the use of transradial pneumatic compression band

BMC Research Notes ◽

10.1186/s13104-020-05323-8 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Kashif Ali Hashmi ◽

Zahid Iqbal ◽

Atif Ali Hashmi ◽

Maira Shoaib ◽

Muhammad Irfan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Radial Artery ◽

Cardiac Catheterization ◽

Age Groups ◽

Vascular Complications ◽

Artery Occlusion ◽

Study Cohort ◽

Coronary Catheterization ◽

Significant Difference ◽

Radial Artery Occlusion

Abstract Objectives Radial artery occlusion is a silent complication of a transradial approach to cardiac catheterization that may complicate subsequent transradial procedures in patients undergoing cardiac catheterization. A transradial band reduces vascular complications and provides brisk, powerful and effective haemostasis. The purpose of this study was to assess the frequency of radial artery occlusion in 180 patients undergoing transradial coronary catheterization. Results The median age of the study cohort was 58 years. Radial artery occlusion was found in 14 (7.8%) patients. When stratifying by age group and sex, there was no significant difference in radial artery occlusion between age groups and sex. It was likewise found that comorbidities such as diabetes mellitus, hypertension and smoking, increased the risk of radial artery occlusion however this was observed to be significant only for diabetes mellitus. We therefore conclude that a transradial pneumatic pressure band is an extremely helpful and safe strategy to prevent radial artery occlusion.

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Abstract 14147: Vascular Complication of Distal Transradial Approach in Patients With Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.14147 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takeshi Yamada ◽

Yuki Matsubara ◽

Soichiro Washimi ◽

Sho Hashimoto ◽

Norimasa Taniguchi ◽

...

Keyword(s):

Myocardial Infarction ◽

Radial Artery ◽

Bleeding Complication ◽

Artery Occlusion ◽

Vascular Complication ◽

Primary Pci ◽

Transradial Approach ◽

The Mean ◽

Radial Artery Occlusion

Background: The distal transradial approach (dTRA) for coronary catheterisation is a newly introduced alternative to the conventional transradial approach. This study investigated the incidence of vascular complication of the dTRA in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods: Consecutive 131 patients with AMI who underwent primary PCI between April 2018 and October 2019 were investigated. The dTRA was used as the primary approach whenever feasible in this study period. The bleeding complication after dTRA and the patency of the radial artery were investigated. The patency of the radial artery was examined using Doppler ultrasound in follow-up period. Results: Among the 131 AMI patients, 116 patients (88.5%) underwent successful primary PCI using the dTRA. The patients included 83 men (71.6%), and the mean age was 70.4 ± 12.9 years. A 5- or 6-French sheath (conventional or slender) was used in the primary procedure. The average time to achieving hemostasis was 5.0 ± 4.1 hours; TIMI minor bleeding was observed in 2 patients (1.5%) and there were no TIMI major bleeding. Color Doppler sonography of the radial artery was performed in 94 patients with the mean follow-up period of 273 ± 183 days, and the incidence of radial artery occlusion (RAO) was 1.1% (n=1). Conclusions: The application of dTRA is considered to have low incidences of bleeding complication and radial artery occlusion in the patients with AMI.

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