Long-term consequences of trans-radial catheterization on the radial artery

Background: The radial artery (RA) is often utilized for diagnostic coronary angiography and percutaneous intervention. Recent high-level evidence supports RA use in preference to saphenous vein as a conduit for coronary revascularization. Aim: To demonstrate gross and histologic changes of the RA following transradial access. Methods: We present two patients who had open RA harvest for coronary bypass surgery after transradial catheterization. Results: Examination 8 years after transradial catheterization demonstrated thickened intima and dissection, and examination 12 years following transradial catheterization with percutaneous coronary intervention demonstrated chronic dissection with thickened intima and near occlusion of the lumen. Conclusion: Transradial access via the RA, even after several years, is associated significant injury, making it unusable as a conduit for surgical coronary revascularization. A RA that has been utilized for catheterization should not be considered for coronary revascularization.

Treatment of Arteriovenous Fistulas and Arteriovenous Malformations

The transradial approach has been increasingly utilized for the diagnosis and treatment of arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) with great success. The proximity of the radial artery catheterization site to the cerebrum has allowed for navigation of the fragile vasculature of AVFs and AVMs with ease and plenty of support. Intraoperative angiography has tremendously benefitted from transradial catheterization due to the ease of radial access regardless of the intricate patient positioning required for microsurgical resection. This chapter provides a detailed account of the technical details of the transradial approach for the treatment of AVF/AVMs.

Clinical accuracy of reverse Barbeau test in the diagnosis of radial artery occlusion after transradial catheterization

Background Radial artery occlusion is an infrequent complication of transradial catheterization. Assessment of radial artery occlusion is a critical aspect of clinical care, and it should be done with an additional test, commonly by a plethysmographic test (reverse Barbeau test) or ultrasound (Doppler), the last is the gold standard. The objective of this study was to evaluate the accuracy of the reverse Barbeau test in detecting radial artery occlusion after transradial catheterization. Methods A study carried out in two centers encompassing patients submitted to procedures by radial access. All patients received at least 5,000IU of heparin. Sheaths were immediately removed after the procedure, using a patent hemostasis protocol. Patency of the radial artery was verified by reverse Barbeau test and duplex Doppler evaluation within the first 24 hours. Results A total of 350 patients were enrolled, with a mean age of 61.7 (±9.7) years. Radial artery occlusion was verified after the procedure in 19 (5.4%) patients, using duplex Doppler scan. Application of reverse Barbeau test had the following results: 64.0% type A curve, 15.7% type B, 8.3% type C, and 12.0% type D (the last suggesting occlusion). With reverse Barbeau test, patients with confirmed occlusion by ultrasound evaluation, 21.1% would be missed by a false-negative test, and in the ones, without radial artery occlusion, 8.2% would be misdiagnosed as having it (sensibility 78.9%; specificity 91.8%). Conclusion Reverse Barbeau test has good accuracy to detect radial artery occlusion, and it is a good option for clinical day use, although using reverse Barbeau test results in the overestimation of radial artery occlusion.

Radial artery occlusion after cardiac catheterization and impact of medical treatment

Summary: Background: The transradial artery approach is the preferred access for cardiac catheterization according to current guidelines. However, the most common complication is radial artery occlusion (RAO). Despite the rare indication for surgical reopening, the occluded radial artery is not available for further procedures or as a potential bypass graft. Still, treatment regimens for RAO are scarce. We now determined whether the addition of antithrombotic to antiplatelet therapy improves the rate of partial or complete regain of patency in RAO following transradial cardiac catheterization in a retrospective analysis. Patients and methods: In a two-center tertiary referral hospital retrospective analysis 4135 files of patients who had undergone transradial catheterization were screened for documented RAO. 141 patients were identified and 138 patients with complete information on the medical regimen and ultrasound examinations for a maximum of 3 months were included in the analysis, whereas 3 patients were excluded due to missing or incomplete follow-up information. Results: 3.3% of all patients that had undergone transradial catheterization featured an oligosymptomatic RAO, confirmed by color-coded duplex sonography. 21% of patients with additional anticoagulation regained full patency vs. 9% without additional anticoagulation (p = 0.07). 40% of patients with anticoagulation featured a partial or full regain of patency vs. 16% of patients without additional anticoagulation for a maximum of 3 months treatment (p = 0.006). No major bleedings were reported during the follow-up visits. Conclusions: RAO remains a rare complication of cardiac catheterization. The addition of antithrombotic therapy for 3 months appears to safely improve the partial or even full regain of radial patency in case of postinterventional RAO.