Access-site Complications of the Transradial Approach: Rare But Still There

Abstract

: 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.

Radial arteriovenous fistula complicated with ischemic steal syndrome after transradial cardiac catheterization: a case report and literature review

“…In patients with acute coronary syndromes (ACS), these benefits are more evident [ 6 ]. Nevertheless, Multiple sequelae encountered with TRA such as radial artery occlusion, hematomas, pseudoaneurysm and AVF, although less frequent, do occur [ 7 ]. The characteristics of previous radial AVF cases relative to catheter-based procedures have been reviewed [ 1 , 3 , 5 , 8 – 21 ].…”

Late massive radial artery pseudoaneurysm following cardiac catheterization: A case report

“…Historically the femoral artery was the initial access site, however with the advent and introduction of the transradial approach, there has been a reduction in access site complications and mortality, a decrease in length of stay, and an overall enhancement of patient comfort [ 3 , 4 ]. The transradial approach has not only increased in prevalence in comparison to the transfemoral approach, it has now become the approach of choice [ 9 ].…”

“…Although the transradial approach has a lower incidence of major access-related complications and is safer than the transfemoral approach, periprocedural complications have been documented. The most common complication is asymptomatic radial artery occlusion, which due to the collateral arterial supply of the hand, only rarely results in adverse events [ 5 , 9 ]. Other commonly reported complications of the radial artery approach include radial artery spasm, non-occlusive arterial injury, and forearm hematoma.…”

Effect of Hand Dominance on Radial Artery Spasm and Occlusion: A Prospective Observational Study

“…4 Due to patient comfort, early discharge from the hospital, and less bleeding and vascular complications, TRA has become preferable to the transfemoral approach even in complex vascular interventions. [5][6][7] TRA has also been shown to be associated with reduced allcause mortality compared with transfemoral access. 3 However, despite these advantages, TRA has some limitations.…”