Management of the access site after transradial percutaneous procedures: literature overview.

The transradial approach (TRA) is emerging as a promising strategy to improve the safety of percutaneous coronary diagnostic or interventional procedures. Nevertheless, a series of specific complications related to the radial access have been described so that their prevention and optimal management is clinically relevant. In this article, the types of access-related vascular complications potentially occurring after TRA and their possible management are described. In particular, the vascular complications have been classified in three groups according to the main pathogenetic mechanism: thrombotic, hemorrhagic and nonthrombotic nonhemorrhagic. Moreover, a practical operative protocol for prompt diagnosis and treatment has been proposed.

[1]  A. M. Leone,et al.  Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures. , 2013, International journal of cardiology.

[2]  A. Shin,et al.  Management of forearm compartment syndrome. , 2012, Critical care nursing clinics of North America.

[3]  G. Laarman,et al.  Critical hand ischaemia after transradial cardiac catheterisation: an uncommon complication of a common procedure , 2012, Netherlands Heart Journal.

[4]  F. Burzotta,et al.  Feasibility of complex coronary and peripheral interventions by trans‐radial approach using large sheaths , 2012, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[5]  A. M. Leone,et al.  Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures. , 2012, American heart journal.

[6]  F. Sozzi,et al.  Angioplasty of below-the-elbow arteries in critical hand ischaemia. , 2012, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[7]  G. Schuler,et al.  The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications. , 2012, JACC. Cardiovascular interventions.

[8]  E. Romagnoli,et al.  Percutaneous antegrade transarterial treatment of iatrogenic radial arteriovenous fistula. , 2012, Journal of cardiovascular medicine.

[9]  S. Pancholy,et al.  Effect of duration of hemostatic compression on radial artery occlusion after transradial access , 2012, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[10]  S. Saito,et al.  Transradial cardiac catheterization: A Review of Access Site Complications , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[11]  Rajiv Gulati,et al.  Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[12]  M. Egred.  Feasibility and safety of 7-Fr radial approach for complex PCI. , 2011, Journal of interventional cardiology.

[13]  S. Pancholy,et al.  Reaccessing an occluded radial artery: a "proximal entry" technique. , 2011, Journal of interventional cardiology.

[14]  E. Roberts,et al.  Management of radial artery perforation during coronary angiography and angioplasty—A report of two cases , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[15]  R. Swaminathan,et al.  Radial access site inflammatory reaction to a recently available hydrophilic coated sheath , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[16]  L. Štěpánková,et al.  Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization. , 2011, The American journal of cardiology.

[17]  J. van der Linden,et al.  Cerebral Microembolism During Coronary Angiography: A Randomized Comparison Between Femoral and Radial Arterial Access , 2011, Stroke.

[18]  Sunil V. Rao,et al.  Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial , 2011, The Lancet.

[19]  D. Dundua,et al.  Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure , 2011, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[20]  G. Sangiorgi,et al.  Randomized clinical trial on short-time compression with Kaolin-filled pad: a new strategy to avoid early bleeding and subacute radial artery occlusion after percutaneous coronary intervention. , 2011, Journal of interventional cardiology.

[21]  Dabit Arzamendi,et al.  Avulsión radial: una complicación rara del intervencionismo coronario , 2011 .

[22]  G. Gosselin,et al.  Radial artery avulsion: a rare complication of percutaneous coronary intervention. , 2011, Revista espanola de cardiologia.

[23]  Joo Young Yang,et al.  A Rare Case of Radial Arteriovenous Fistula After Coronary Angiography , 2010, Korean circulation journal.

[24]  M. Saririan,et al.  Sterile granuloma formation following radial artery catheterization: Too many Cooks? , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[25]  C. Caussin,et al.  Reduction in spasm with a long hydrophylic transradial sheath , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[26]  W. Cantor,et al.  Comparison of bivalirudin versus heparin on radial artery occlusion after transradial catheterization , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[27]  T. Mann,et al.  Hand ischemia resulting from a transradial intervention: Successful management with radial artery angioplasty , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[28]  M. Andrassy,et al.  Radial artery thrombosis following transradial coronary angiography: incidence and rationale for treatment of symptomatic patients with low-molecular-weight heparins , 2010, Clinical Research in Cardiology.

[29]  F. Burzotta,et al.  How to manage difficult anatomic conditions affecting transradial approach coronary procedures? , 2010, Indian heart journal.

[30]  R. Stables,et al.  Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. , 2010, JACC. Cardiovascular interventions.

[31]  Ya‐wei Xu,et al.  Comparative study on transradial versus transfemoral approach for primary percutaneous coronary intervention in Chinese patients with acute myocardial infarction. , 2010, Saudi medical journal.

[32]  M. Mamas,et al.  Use of the sheathless guide catheter during routine transradial percutaneous coronary intervention: A feasibility study , 2009, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[33]  C. Izgi,et al.  Effectiveness of enoxaparin for prevention of radial artery occlusion after transradial cardiac catheterization , 2010, Journal of Thrombosis and Thrombolysis.

[34]  D. Bandorski,et al.  A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. , 2009, JACC. Cardiovascular interventions.

[35]  S. Pancholy.  Comparison of the effect of intra-arterial versus intravenous heparin on radial artery occlusion after transradial catheterization. , 2009, The American journal of cardiology.

[36]  D. Sado,et al.  Sterile granuloma formation following radial artery facilitated coronary catheterization , 2009, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[37]  J. Núñez,et al.  Acceso radial izquierdo en la práctica diaria. Estudio aleatorizado para comparar los accesos femoral, radial derecho y radial izquierdo , 2009 .

[38]  M. McEntegart,et al.  An unusual complication of transradial coronary angiography. , 2009, The Journal of invasive cardiology.

[39]  J. Núñez,et al.  The left radial approach in daily practice. A randomized study comparing femoral and right and left radial approaches. , 2009, Revista espanola de cardiologia.

[40]  Thomas Pero,et al.  Pseudoaneurysm of the Radial Artery Diagnosed by Bedside Ultrasound , 2009, The western journal of emergency medicine.

[41]  L. Pastor,et al.  Radial compression guided by mean artery pressure versus standard compression with a pneumatic device (RACOMAP) , 2009, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[42]  S. Gunasekaran,et al.  Radial artery perforation and its management during PCI. , 2009, The Journal of invasive cardiology.

[43]  Salim Yusuf,et al.  Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. , 2009, American heart journal.

[44]  A. Sokal,et al.  RADIal versus femoral approach for percutaneous coronary interventions in patients with Acute Myocardial Infarction (RADIAMI): A prospective, randomized, single-center clinical trial. , 2009, Cardiology journal.

[45]  S. Achenbach,et al.  Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age , 2008, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[46]  D. Tharmaratnam,et al.  Sterile abscess formation as a complication of hydrophilic radial artery cannulation. , 2008, International journal of cardiology.

[47]  H. Tizón-Marcos,et al.  Incidence of compartment syndrome of the arm in a large series of transradial approach for coronary procedures. , 2008, Journal of interventional cardiology.

[48]  S. Pancholy,et al.  Prevention of radial artery occlusion—Patent hemostasis evaluation trial (PROPHET study): A randomized comparison of traditional versus patency documented hemostasis after transradial catheterization , 2008, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[49]  S. Saito,et al.  Percutaneous coronary intervention using a novel 4‐French coronary accessor , 2008, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[50]  Yu-jie Zhou,et al.  Safety and feasibility of transradial approach for primary percutaneous coronary intervention in elderly patients with acute myocardial infarction , 2008, Chinese medical journal.

[51]  R. Rüppel,et al.  Hydrophilic-coated sheaths increase the success rate of transradial coronary procedures and reduce patient discomfort but do not reduce the occlusion rate: randomized single-blind comparison of coated vs. non-coated sheaths , 2008, Clinical Research in Cardiology.

[52]  S. Pancholy.  Transradial access in an occluded radial artery: new technique. , 2007, The Journal of invasive cardiology.

[53]  D. Newby,et al.  Reduced vascular complications and length of stay with transradial rescue angioplasty for acute myocardial infarction , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[54]  A. Íñiguez,et al.  Interruption of blood flow during compression and radial artery occlusion after transradial catheterization , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[55]  F. Burzotta,et al.  Silent cerebral infarct after cardiac catheterization as detected by diffusion weighted Magnetic Resonance Imaging: a randomized comparison of radial and femoral arterial approaches , 2007, Trials.

[56]  V. Pasceri,et al.  Comparison of access-related bleeding complications in women versus men undergoing percutaneous coronary catheterization using the radial versus femoral artery. , 2007, The American journal of cardiology.

[57]  Y. Gong,et al.  Safety and feasibility of emergent percutaneous coronary intervention with the transradial access in patients with acute myocardial infarction. , 2007, Chinese medical journal.

[58]  M. Hamon,et al.  Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI Trial , 2006, Heart.

[59]  K. Bougrini,et al.  Transulnar versus transradial artery approach for coronary angioplasty: The PCVI‐CUBA study , 2006, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[60]  E. Fretz,et al.  Vascular communications of the hand in patients being considered for transradial coronary angiography: is the Allen's test accurate? , 2005, Journal of the American College of Cardiology.

[61]  B. Strauss,et al.  Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction--the RADIAL-AMI pilot randomized trial. , 2005, American heart journal.

[62]  B. Yoo,et al.  Feasibility of the Radial Artery as a Vascular Access Route in Performing Primary Percutaneous Coronary Intervention , 2005, Yonsei medical journal.

[63]  R. J. Valentine,et al.  Hand ischemia after radial artery cannulation. , 2005, Journal of the American College of Surgeons.

[64]  B. Yoo,et al.  Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity. , 2005, International journal of cardiology.

[65]  G. Laarman,et al.  Outpatient coronary angioplasty: Feasible and safe , 2005, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[66]  J. T. Mann,et al.  Problems and complications of the transradial approach for coronary interventions: a review. , 2005, The Journal of invasive cardiology.

[67]  P. Garot,et al.  Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study). , 2004, The American journal of cardiology.

[68]  C. Rogers,et al.  Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients. , 2004, The American journal of cardiology.

[69]  W. Nolan,et al.  Forearm Compartment Syndrome: Anatomical Analysis of Surgical Approaches to the Deep Space , 2004, Plastic and reconstructive surgery.

[70]  G. Biondi-Zoccai,et al.  Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. , 2004, Journal of the American College of Cardiology.

[71]  M. Sanmartín,et al.  Complicaciones vasculares asociadas al acceso transradial para el cateterismo cardíaco , 2004 .

[72]  P. Brewster,et al.  Randomized comparison of rapid ambulation using radial, 4 French femoral access, or femoral access with AngioSeal closure , 2004, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[73]  J. Goicolea,et al.  [Vascular complications associated with radial artery access for cardiac catheterization]. , 2004, Revista espanola de cardiologia.

[74]  Serge Simard,et al.  Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients. , 2004, American heart journal.

[75]  D. Benharroch,et al.  Extraction of the radial artery during transradial coronary angiography: an unusual complication. , 2003, The Journal of invasive cardiology.

[76]  C. White,et al.  Nonhealing wound resulting from a foreign‐body reaction to a radial arterial sheath , 2003, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[77]  C. Chambers,et al.  Sterile inflammation associated with transradial catheterization and hydrophilic sheaths , 2003, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[78]  S. Saito,et al.  Comparative study on transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: Results of the test for myocardial infarction by prospective unicenter randomization for access sites (TEMPURA) trial , 2003, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[79]  H. Völzke,et al.  A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions , 2002, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[80]  J. Dery,et al.  Reduction of discomfort at sheath removal during transradial coronary procedures with the use of a hydrophilic‐coated sheath , 2001, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[81]  S. Kohno,et al.  Limitations of successive transradial approach in the same arm: The Japanese experience , 2001, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[82]  J. C. Brito,et al.  Transradial approach for coronary interventions. , 2001, Arquivos brasileiros de cardiologia.

[83]  M. Morice,et al.  Coronary angiography through the radial or the femoral approach: The CARAFE study , 2001, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[84]  C. Cooper,et al.  8 french transradial coronary interventions: clinical outcome and late effects on the radial artery and hand function. , 2000, The Journal of invasive cardiology.

[85]  E. Neymark,et al.  Radial artery mycotic pseudoaneurysm: An unusual complication of catheterization , 2000, Journal of clinical ultrasound : JCU.

[86]  N. Yokoyama,et al.  Anatomic variations of the radial artery in patients undergoing transradial coronary intervention , 2000, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[87]  D. Cohen,et al.  Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. , 1999, American heart journal.

[88]  S. Saito,et al.  Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention , 1999, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[89]  J. Schneider,et al.  Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. , 1998, Journal of the American College of Cardiology.

[90]  L. Missault,et al.  Brachial, radial, or femoral approach for elective Palmaz-Schatz stent implantation: a randomized comparison. , 1997, Catheterization and cardiovascular diagnosis.

[91]  G. Laarman,et al.  A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. , 1997, Journal of the American College of Cardiology.

[92]  P. Stella,et al.  Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. , 1997, Catheterization and cardiovascular diagnosis.

[93]  P. Vranckx,et al.  Frequency of a positive modified Allen's test in 1,000 consecutive patients undergoing cardiac catheterization. , 1996, Catheterization and cardiovascular diagnosis.

[94]  M. Mick,et al.  Ultrasound imaging of the radial artery following its use for cardiac catheterization. , 1996, The American journal of cardiology.

[95]  G. Laarman,et al.  Percutaneous transradial artery approach for coronary stent implantation. , 1993, Catheterization and cardiovascular diagnosis.

[96]  P. Scuderi,et al.  Infected radial artery pseudoaneurysms occurring after percutaneous cannulation. , 1992, Chest.

[97]  K. Pieper,et al.  Vascular complications of cardiac catheterization. , 1991, Journal of vascular surgery.

[98]  D. Salter,et al.  Radial artery infections and aneurysms after catheterization. , 1990, The Journal of hand surgery.

[99]  R. Glaser,et al.  Arteriovenous fistulas after cardiac catheterization. , 1989, Archives of surgery.

[100]  L. Campeau,et al.  Percutaneous radial artery approach for coronary angiography. , 1989, Catheterization and cardiovascular diagnosis.