Incidence and Predictors of Radial Artery Occlusion Associated Transradial Catheterization (original) (raw)
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JACC. Cardiovascular interventions, 2016
The study sought to evaluate whether prophylactic ipsilateral ulnar artery compression during radial artery hemostasis could reduce the risk of radial artery occlusion (RAO). RAO after transradial access (TRA) is a structural complication of TRA. It limits future ipsilateral TRA and may cause transient pain. Maintaining radial artery flow during hemostasis reduces the incidence of acute RAO. Ipsilateral ulnar compression increases radial artery flow and could impact the incidence of RAO. Three thousand patients undergoing diagnostic cardiac catheterization using TRA were randomized to receive either standard patent hemostasis protocol (Group I) or prophylactic ipsilateral ulnar compression in addition to patent hemostasis (Group II). Using plethysmography, radial artery patency was evaluated at the time of removal of the compression device as well as 24 h and 30 days after the procedure. The primary study endpoint was 30-day RAO. The primary endpoint, 30-day RAO, was significantly r...
Cardiology Journal, 2014
. To our knowledge, there is no satisfactory data regarding the late term incidence and predictors of RAO in the literature. Our aim was to establish the long-term incidence of radial artery occlusion and investigate its predictors. Methods: This was a single center prospective study. A total number of 409 consecutive patients undergoing their first TRA were recruited. Clinical and procedural data were all recorded. Doppler ultrasound examination was performed at 6-15 months following the intervention. Results: RAO was detected in 67 patients and 342 patients maintained radial artery patency. The overall RAO incidence was 16.4% at late term. Patients with RAO were younger than the patients with patent radial arteries (55.9 ± 9.7 vs. 59.1 ± 9.4 years, p = 0.014). The incidence of RAO in hypertensive patients (9.8%) was lower (p < 0.001) than the observed incidence (23%) in non-hypertensive patients. RAO group had higher rate (28%, p = 0.027) of post--procedural access site pain. Regression analysis revealed that hypertension was negative while post-procedural access site pain was positive independent predictors for RAO. In addition, the relative risk for RAO also increased significantly (p < 0.001) when the ratio of sheath/artery diameter (S/A) was > 1. Conclusions: The present study reveals that the long-term incidence of RAO is 16.4%. Hypertension, post-procedural access site pain and S/A ratio > 1 are independent predictors of RAO at late term. (Cardiol J 2014; 21, 4: 350-356)
Angiology, 2018
Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As "it may all be ap...
PubMed, 2015
Objectives: To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coronary angioplasty (TRA). Background: RAO can occur after TRA but has not been well studied by serial vascular Doppler examination. Methods: A total of 198 patients undergoing TRA were included. Radial pulse and Doppler examination of the radial artery were performed 1 day before, 1 day after, and 3 months after the procedure. RAO was defined as an absence of antegrade flow on Doppler studies. Logistic regression analysis was done to evaluate the predictors of RAO. Results: The mean radial arterial diameter was 2.8 ± 0.4 mm. On the day after TRA, radial artery Doppler examination revealed RAO in 30 patients (15.2%). Radial pulse was still palpable in 30.0% of these patients. All of them were asymptomatic. At 3-month follow-up, no new RAO was noted. Interestingly, the radial artery had spontaneously recanalized in 8 patients (26.7%) with RAO. Patients with persistent RAO remained asymptomatic. On univariate analysis, female sex, diabetes, lower body mass index, radial artery diameter ≤2.5 mm, lower peak systolic velocity, and radial artery to sheath ratio <1 were predictors of RAO. Interestingly, procedural characteristics and duration of the procedure were not identified as predictors of RAO. On multivariate analysis, radial artery diameter ≤2.5 mm and preprocedural peak systolic velocity emerged as independent predictors for RAO. Conclusion: Asymptomatic RAO occurs in about 15% of patients after TRA. Spontaneous recanalization occurs in about one-fourth of these patients. Preprocedure radial artery inner diameter ≤2.5 mm and peak systolic velocity are the independent predictors of RAO.
JACC: Cardiovascular Interventions, 2019
Transradial access (TRA) is increasingly used worldwide for percutaneous interventional procedures and associated with lower bleeding and vascular complications than transfemoral artery access. Radial artery occlusion (RAO) is the most frequent post-procedural complication of TRA, restricting the use of the same radial artery for future procedures and as a conduit for coronary artery bypass graft. The authors review recent advances in the prevention of RAO following percutaneous TRA diagnostic or interventional procedures. Based on the available data, the authors provide easily applicable and effective recommendations to prevent periprocedural RAO and maximize the chances of access in case of repeat catheterization or coronary artery bypass grafting surgery.
Catheterization and Cardiovascular Interventions, 2008
Objective: The objective of this study was to evaluate the efficacy of hemostasis with patency in avoiding radial artery occlusion after transradial catheterization. Background: Radial artery occlusion is an infrequent but discouraging complication of transradial access. It is related to factors such as sheath to artery ratio and is less common in patients receiving heparin. Despite being clinically silent in most cases, it limits future transradial access. Patients and Methods: Four hundred thirty-six consecutive patients undergoing transradial catheterization were prospectively enrolled in the study. Two hundred nineteen patients were randomized to group I, and underwent conventional pressure application for hemostasis. Two hundred seventeen patients were randomized to group II and underwent pressure application confirming radial artery patency using Barbeau's test. Radial artery patency was studied at 24 hr and 30 days using Barbeau's test. Results: Thirty-eight patients had evidence of radial artery occlusion at 24 hr. Twenty patients had persistent evidence of radial artery occlusion at 1 month. Group II, with documented patency during hemostatic compression, had a statistically and clinically lower incidence of radial artery occlusion (59% decrease at 24 hr and 75% decrease at 30 days, P < 0.05), compared with patients in group I. Low body weight patients were at significantly higher risk of radial artery occlusion. No procedural variables were found to be associated with radial artery occlusion. Conclusion: Patent hemostasis is highly effective in reducing radial artery occlusion after radial access and guided compression should be performed to maintain radial artery patency at the time of hemostasis, to prevent future radial artery occlusion. © 2008 Wiley-Liss, Inc.
The Anatolian Journal of Cardiology, 2022
Transfemoral vascular access is the most common approach for both diagnostic as well as therapeutic coronary interventions; however, higher rate of vascular complications and bleeding have been reported especially in women and older patients than with radial access (1). Transradial approach (TRA) is now being increasingly used and is the preferred vascular access for cardiac interventions (2). TRA offers advantages such as minimal invasion, ease of performance of diagnostic and therapeutic coronary interventions, minimum patient discomfort, early ambulation, shorter hospital stay, and lower hospital costs (3-7). In addition, there are lower local site complications, morbidity, and mortality in patients who specifically present with acute coronary syndromes (6, 7). Radial artery occlusion (RAO) is one of the most frequent complications of TRA that affects a sizeable proportion of patients (8, 9). Post transradial coronary intervention (TCI), early RAO may occur because of radial artery spasm and thrombosis, which may be precipitated by combined effects of catheter-induced endothelial injury and decrease in blood flow after sheath and catheter insertion (8). The incidence of RAO varies in different studies ranging from 1% to 42%, and has been determined by the timing of evaluation and the method used for the diagnosis of RAO. Various patient-specific and procedure-related factors influence the occurrence and consequences of RAO (8-17). However, the predictors of RAO after TCI are not clearly defined. In this study, we determine the incidence and patient-specific and procedure-related predictors of RAO among patients undergoing TCI.
Bangladesh Heart Journal, 2019
Background: Although transradial approach (TRA) has better outcome and reduced vascular complications, radial artery occlusion (RAO) is now a major concern as it limits future radial artery use for further TRA, for use as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in CKD patients. Vascular doppler study is the most accurate method for evaluation of RAO and yet this is not practiced in our population. Objectives: To detect the frequency and identify the predictors of RAO after coronary procedure through TRA. Methods: This cross-sectional analytical study was done in the department of cardiology, NICVD from July-2015 to June- 2016 by including a total 125 patients undergoing coronary procedures (CAG and/or PCI) through TRA. Vascular doppler study of the radial artery were performed before and one day after the procedure. RAO was defined as an absence of antegrade flow and monophasic flow on doppler study. Univa...
Cardiovascular Intervention and Therapeutics, 2023
Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidencebased protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, in the conventional protocol, fixed amount of air was removed soon after the procedure, 2 h later, and 3 h later, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1842 patients (71 ± 10 years old, 77% male) were included. Compared with the traditional protocol group (n = 1001), the new protocol group (n = 841) had a significantly lower rate of dual antiplatelet therapy (35% and 24% in the traditional and new groups, respectively, p < 0.001). The time required for complete hemostasis was approximately one-third with the new protocol (190 ± 16 and 66 ± 32 min, p < 0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p < 0.001). After adjusting for covariates, the new protocol was associated with a reduced risk of RAO (odds ratio 0.10, p < 0.001) and a shorter hemostasis time (odds ratio 0.01, p < 0.001). The new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.