Access-site complications of the transradial approach: Rare but still there.

2020 ◽  
Vol 16 ◽  
Author(s):  
Stelina Alkagiet ◽  
Dimitrios Petroglou ◽  
Dimitrios N. Nikas ◽  
Theofilos M. Kolettis
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Access Site ◽  
Transradial Approach ◽  
Financial Benefits ◽  
Eversion Endarterectomy ◽  
Life Threatening ◽  
Sheath Insertion ◽  
Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

Abstract 14475: Successive Distal Transradial Approach for Coronary Catheterization in the Same Arm

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takeshi Yamada ◽  
Soichiro Washimi ◽  
yuki matsubara ◽  
Sho Hashimoto ◽  
Norimasa Taniguchi ◽  
...  
Keyword(s):  
Radial Artery ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Artery Occlusion ◽  
Access Site ◽  
Transradial Approach ◽  
Coronary Catheterization ◽  
Initial Procedure ◽  
Second Procedure ◽  
Distal Radial Artery

Background: The distal transradial approach (dTRA) for coronary catheterization is a newly introduced alternative to the conventional transradial approach. This study investigated how many times the same distal radial artery can be cannulated for coronary catheterization. Methods: A total of 1717 patients underwent 2406 coronary catheterization procedures between April 2018 and March 2020. The dTRA was used as the primary approach whenever feasible in this study period, and the dTRA was used for 1555 patients (90.6%) and 2129 procedures (88.5%). Patients who underwent repeated coronary catheterization after the initial procedure using dTRA were included in this study. The incidence of successive application of dTRA in the same arm and the reasons for access site conversion were investigated. Results: A total of 430 patients were included in this study; of these, in 10 patients, the distal radial artery was cannulated on both sides in the initial procedure. The patient group included 320 men (74.4%), and the mean age was 72.2 ± 10.8 years. A 4-, 5-, or 6-French sheath or sheathless system was used in the initial procedure. A maximum of four successive coronary catheterization procedures, including the initial procedure, were carried out. The second procedure involved the distal radial artery on the same side in 394 cases (89.5%), and the fourth dTRA procedure was possible in 81.7% of the cases. Access site conversion during the follow-up procedure, which was observed in 57 cases, was attributed to radial artery occlusion (17.5%), narrowing of the distal radial artery (33.4%), tortuous route of the right upper limb approach (15.8%), and strategic reasons, such as aortography or coronary bypass graft angiography (15.8%). Conclusions: The dTRA was successfully applied in the same arm in 89.5% of the cases in the second procedure and 81.7% in the fourth coronary catheterization procedure.

scholarly journals Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test

2020 ◽  
Vol 22 (Supplement_F) ◽  
pp. F23-F29
Author(s):  
Stepan Jirous ◽  
Ivo Bernat ◽  
David Slezak ◽  
Roman Miklik ◽  
Richard Rokyta
Keyword(s):  
Radial Artery ◽  
Duplex Ultrasound ◽  
Artery Occlusion ◽  
Duplex Ultrasonography ◽  
Transradial Approach ◽  
Local Complications ◽  
Compression Time ◽  
First Choice ◽  
Same Day Discharge ◽  
Radial Artery Occlusion

Abstract The transradial approach is recommended as a first choice in coronary catheterizations and interventions, for among other reasons, the reduction in the number of local complications. A head-to-head comparison of the reverse Barbeau test (RBT) and duplex ultrasonography (DUSG) for the detection of post-procedural radial artery patency and occlusion has not yet been evaluated. In 500 patients from our same-day discharge program (age 65 ± 9.4 years, 148 women), radial artery patency and occlusion, compression time, haematomas, and other local complications were evaluated. Radial artery patency was confirmed in 495 patients (99.0%), and complete radial artery occlusion (RAO) was detected in 2 (0.4%) patients using both methods. In 3 patients (0.6%), the RBT was negative, while incomplete RAO was detected by DUSG. Superficial haematomas (˃ 5 but ≤10 cm) were found in 27 (5.4%) patients. There were no other local complications. Detection of radial artery patency and occlusion using the RBT and DUSG was comparable. The incidence of RAO in our study was extremely low. Thanks to its simplicity, the RBT has the potential to be used as the first method of detection of radial occlusion after coronary catheterizations.

Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 74-82 ◽  
Author(s):  
Matteo Tebaldi ◽  
Simone Biscaglia ◽  
Carlo Tumscitz ◽  
Annamaria Del Franco ◽  
Francesco Gallo ◽  
...  
Keyword(s):  
Radial Artery ◽  
Primary Outcome ◽  
Study Groups ◽  
Adjunctive Treatment ◽  
Access Site ◽  
Double Blind ◽  
Access Site Complication ◽  
Heparin Administration ◽  
Coronary Procedures ◽  
Sheath Insertion

Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery oc­clusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

scholarly journals Randomized Comparison of Terumo® Coated Slender™ versus Terumo® Noncoated Traditional Sheath during Radial Angiography or Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Birthe Sindberg ◽  
Christel Gry Aagren Nielsen ◽  
Marianne Hestbjerg Poulsen ◽  
Martin Bøhme Rasmussen ◽  
Steen Carstensen ◽  
...  
Keyword(s):  
Radial Artery ◽  
Rating Scale ◽  
Coronary Intervention ◽  
Numeric Rating Scale ◽  
Artery Occlusion ◽  
Success Rates ◽  
Femoral Access ◽  
Procedural Success ◽  
And Gender ◽  
Sheath Insertion

Background. The transradial approach is generally associated with few complications. However, periprocedural pain is still a common issue, potentially related to sheath insertion and/or arterial spasm, and may result in conversion to femoral access. Radial artery occlusion (RAO) following the procedure is also a potential risk. We evaluate whether the design of the sheath has any impact on these variables. Methods. A total of 1,000 patients scheduled for radial CAG or PCI were randomized (1:1) to the use of a Slender or a Standard sheath during the procedure. Randomization was stratified according to chosen sheath size (5, 6, 7 French) and gender. A radial band was used to obtain hemostasis after the procedure, employing a rapid deflation technique. A reverse Barbeau test was performed to evaluate radial artery patency after removal of the radial band, and level of pain was assessed using a numeric rating scale (NRS). Results. Use of the Slender sheath was associated with less pain during sheath insertion (median NRS 1 versus 2, p=0.02), whereas no difference was observed in pain during the procedure, radial procedural success rates, use of analgesics and sedatives during the procedure, and radial artery patency following the procedure. Rate of RAO was 1.5% with no difference between groups. Conclusion. The use of the hydrophilic coated Slender sheath during radial CAG or PCI was associated with less pain during sheath insertion, whereas no difference in other endpoints was observed. A rapid deflation technique was associated with RAO of only 1.5%.

scholarly journals Safety and feasibility of the distal transradial approach: A novel technique for diagnostic cerebral angiography

2020 ◽  
Vol 26 (6) ◽  
pp. 713-718
Author(s):  
Shoji Saito ◽  
Hitoshi Hasegawa ◽  
Tomoyoshi Ota ◽  
Toru Takino ◽  
Yuichi Yoshida ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Artery Occlusion ◽  
Transradial Approach ◽  
Novel Technique ◽  
Ultrasound Evaluation ◽  
The Mean ◽  
Cannulation Success Rate ◽  
Cannulation Success ◽  
Distal Radial Artery

Purpose We aimed to evaluate the safety and feasibility of the distal transradial approach (DTRA) as a novel technique for cerebral angiography based on our institutional initial experience. Methods We retrospectively analyzed our institutional database of consecutive diagnostic cerebral angiographies performed with DTRA from December 2018 to August 2019. Patient demographics and clinical and procedural data were recorded. Results In total, 51 diagnostic cerebral angiographies in 51 patients (age, 15–83 years; mean age, 59.4 years, SD 13.5; 35 (69%) females) were performed or attempted with DTRA. Ultrasound evaluation showed that the mean inner distal radial artery diameter was significantly smaller than the mean inner forearm radial artery diameter (2.19 mm vs. 2.56 mm, P < 0.001). Cannulation via the distal radial artery was successful in 47 (92%) procedures. In the four procedures that failed, operators converted to the ipsilateral transradial approach without repositioning or redraping. Selective catheterization of the intended vessel was achieved in 64 (91%) of 70 vessels. In the remaining six, operators achieved the objective of the examination with angiography injecting from proximal and conversion to another approach was not required. One patient experienced temporary numbness around the puncture site after the procedure. No radial artery occlusion was identified in the patients who underwent ultrasound evaluation. Conclusion Our results demonstrate that DTRA could become a standard approach for diagnostic cerebral angiography owing to the low complication rate and the high cannulation success rate.

Transradial access for neurointerventions: management of access challenges and complications

2019 ◽  
Vol 12 (1) ◽  
pp. 82-86 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Eric C Peterson
Keyword(s):  
Radial Artery ◽  
Randomized Trials ◽  
Endovascular Procedures ◽  
Anatomical Variations ◽  
Artery Occlusion ◽  
Morbidity And Mortality ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
The Common ◽  
Catheter Knots

BackgroundNumerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.MethodA careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.ResultsA stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.ConclusionThe ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Ruzsa ◽  
N Sandor ◽  
J Toth ◽  
M Deak ◽  
B Zafirovska ◽  
...  
Keyword(s):  
Radial Artery ◽  
Subclavian Artery ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Access Site Complication ◽  
Radial Access ◽  
Angiographic Data ◽  
Procedural Complications ◽  
Radial Artery Occlusion

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&lt;0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

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

Circulation ◽  
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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