Arterial Injury During Radial Percutaneous Coronary Intervention

Chapter

Abstract

Compared to the transfemoral (TF) route, percutaneous cardiac procedures performed via a transradial (TR) approach are associated with significantly lower morbidity and are more cost-effective. Despite these practical advantages, TR procedures may be associated with vascular injuries and complications. The common complications encountered are RA spasm and RA occlusion. Rarely perforation or dissection of the RA, pseudoaneurysm, arteriovenous fistula formation and compartment syndrome can occur. Although all of these complications have been reported they are infrequent with the TR approach. Most of these are preventable with good patient preparation and optimal radial technique. When complications do occur they are usually not life or limb threatening and can be managed conservatively.

Keywords

Radial injuries Radial complications Access site complications 

References

  1. 1.
    Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006;114:774–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. ACUITY Investigators. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Bertrand OF, De Larochellière R, Rodés-Cabau J, Proulx G, Gleeton O, Nguyen CM, et al. Early discharge after transradial stenting of coronary arteries study investigators. A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation. 2006;114:2636–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Caussin C, Gharbi M, Durier C, Ghostine S, Pesenti-Rossi D, Rahal S, et al. Reduction in spasm with a long hydrophylic transradial sheath. Catheter Cardiovasc Interv. 2010;76:668–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, Perry RA, Morris JL. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv. 2010;3:475–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Koga S, Ikeda S, Futagawa K, Sonoda K, Yoshitake T, Miyahara Y, Kohno S. The use of a hydrophilic-coated catheter during transradial cardiac catheterization is associated with a low incidence of radial artery spasm. Int J Cardiol. 2004;96:255–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Kiemeneij F, Vajifdar BU, Eccleshall SC, Laarman G, Slagboom T, van der Wieken R. Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures. Catheter Cardiovasc Interv. 2003;58:281–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Chen CW, Lin CL, Lin TK, Lin CD. A simple and effective regimen for prevention of radial artery spasm during coronary catheterization. Cardiology. 2006;105:43–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Varenne O, Jégou A, Cohen R, Empana JP, Salengro E, Ohanessian A, Gaultier C, Allouch P, et al. Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study. Catheter Cardiovasc Interv. 2006;68:231–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Nagai S, Abe S, Sato T, Hozawa K, Yuki K, Hanashima K, Tomoike H. Ultrasonic assessment of vascular complications in coronary angiography and angioplasty after transradial approach. Am J Cardiol. 1999;83:180–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Spaulding C, Lefèvre T, Funck F, Thébault B, Chauveau M, et al. Left radial approach for coronary angiography: results of a prospective study. Catheter Cardiovasc Interv. 1996;39:365–70.CrossRefGoogle Scholar
  12. 12.
    Bernat I, Bertrand OF, Rokyta R, Kacer M, Pesek J, Koza J, et al. Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization. Am J Cardiol. 2011;107:1698–701.CrossRefPubMedGoogle Scholar
  13. 13.
    Saito S, Ikei H, Hosokawa G, Tanaka S. Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention. Catheter Cardiovasc Interv. 1999;46:173–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Saito S, Miyake S, Hosokawa G, Tanaka S, Kawamitsu K, Kaneda H, Ikei H, Shiono T. Transradial coronary intervention in Japanese patients. Catheter Cardiovasc Interv. 1999;46:37–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Uhlemann M, Möbius-Winkler S, Mende M, Eitel I, Fuernau G, Sandri M, Adams V, Thiele H, Linke A, Schuler G, Gielen S. The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications. JACC Cardiovasc Interv. 2012;5:36–43.CrossRefPubMedGoogle Scholar
  16. 16.
    Pancholy S, Coppola J, Patel T, Roke-Thomas M. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv. 2008;72:335–40.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineUniversity Hospitals of Coventry and WarwickshireCoventryUK
  2. 2.Department of CardiologyUniversity Hospital of North Staffordshire, University Hospital of North Staffordshire NHS TrustStoke-on-TrentUK

Personalised recommendations