Access-site hematoma in distal and conventional transradial access: a randomized trial

Lucreziotti, Stefano; Persampieri, Simone; Gentile, Domitilla; Barbieri, Lucia; Salerno‐Uriarte, Diego; Valli, F; Sabatelli, Ludovico; Panzacchi, G; Centola, Marco; Carugo, Stefano

doi:10.23736/s2724-5683.21.05483-9

Cited by 13 publications

(29 citation statements)

References 33 publications

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“…Baseline studies characteristics included multinational single and multicenter studies published between 2017 and 2022 with enrollment periods spanning from 2016 to 2021. Studies included 11 randomized control trials 4,5,17,[22][23][24][25][26][27][28][29] and the remainder were nonrandomized control or observational studies. 3,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The follow-up postcatheterization ranged from 1 day 28,35,36 to 6 months.…”

Section: Resultsmentioning

confidence: 99%

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Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta‐analysis

Feghaly

Chen

Blanco

et al. 2023

Cathet Cardio Intervent

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Background The distal radial artery (DRA) access is an alternative to the conventional radial artery (CRA) access for coronary angiography and interventions and appears to be associated with reduced incidence of certain outcomes. Methods A systematic review was performed to evaluate differences between DRA versus CRA access for coronary angiography and/or interventions. Following preferred reporting items for systematic review and meta‐analysis‐protocols guidelines, two reviewers independently selected studies published in the electronic databases (MEDLINE, EMBASE, SCOPUS, CENTRAL) from inception to October 10, 2022, followed by data extraction, meta‐analysis, and quality assessment. Results The final review included 28 studies with (total: 9151 patients [DRA: 4474; CRA: 4677]). Compared with CRA, DRA access was found to be associated with a shorter time to achieve hemostasis (mean difference, MD: −32.49 [95% confidence interval, CI: −65.53, −2.46], p < 0.00001), and reduced incidence of radial artery occlusion (RAO) (risk ratio, RR: 0.38 [95% CI: 0.25, 0.57], p < 0.00001), any bleeding (RR: 0.44 [95% CI: 0.22, 0.86], p = 0.02), and pseudoaneurysm (RR: 0.41 [95% CI: 0.18, 0.99], p = 0.05). However, DRA access has increased access time (MD: 0.31 [95% CI: −0.09, 0.71], p < 0.00001) and crossover rates (RR: 2.75 [95% CI: 1.70, 4.44], p < 0.00001). There were no statistically significant differences in other technical aspects and complications. Conclusion DRA access is a safe and feasible approach for coronary angiography and interventions. Compared to CRA, DRA provides a shorter hemostasis time, lower incidence of RAO, any bleeding, and pseudoaneurysm, and is associated with increased access time and crossover rates.

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Section: Resultsmentioning

confidence: 99%

“…Thirteen studies assessed access time (minutes). 3,4,22,24,26,27,29,31,32,34,40,42,44 Six studies assessed rates of successful access on the first attempt. 4,24,28,37,41 Thirteen studies assessed crossover to alternative arterial access rate.…”

Section: Procedural Outcomesmentioning

confidence: 99%

Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta‐analysis

Feghaly

Chen

Blanco

et al. 2023

Cathet Cardio Intervent

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“…Then, the full-texts of the remaining 11 studies were reviewed, and 5 additional studies were excluded. Finally, 6 studies [ 8 , 12 – 16 ] were included in this meta-analysis. The processes of screening are shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis

Cao

Cai

Liu

et al. 2021

Journal of Interventional Cardiology

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Objectives. Searching the literature for coronary angiography (CAG) or intervention through distal radial access (DRA) and performing a meta-analysis. Background. Coronary angiography (CAG) or intervention through distal radial access (DRA) may have a similar success rate, low radial artery occlusion rate, low radial artery spasm rate, and low rate of puncture site hematoma for patients with coronary heart disease. Therefore, the randomized controlled trials (RCTs) were searched, and the data were pooled for meta-analysis to evaluate the effectiveness and safety of DRA. Methods. RCTs comparing the CAG or intervention through DRA vs. transradial access (TRA) published between January 1, 2017, and May 4, 2021, were searched in the PubMed, Embase, and Cochrane databases. The endpoints included the rate of access success and the number of radial artery occlusions, radial artery spasms, and puncture site hematomas. The data were extracted, and a random-effects model was used for analysis. Results. Among 204 studies, 6 RCTs (with 2825 participants) met the inclusion criteria. Compared to TRA, the access success rate in DRA ( p = 0.1 ) and the lower rate of puncture site hematoma were not significantly different ( p = 0.646 ), while the radial artery occlusion rate ( p < 0.001 ) and radial artery spasm rate ( p = 0.029 ) were significantly lower. Conclusion. In summary, DRA has a similar access success rate and incidence of hematoma at the puncture site, but a lower incidence of RAO and spasm compared to TRA. These findings demonstrated that DRA is a safe and effective access for CAG or intervention.

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“…But on contrary they didn’t report any case with RAO on both groups as we found 7 cases with conventional TRA arm. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Distal radial approach between theory and clinical practice.. Time to go distal!

et al. 2022

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Background Transradial access (TRA), which has a minimal risk of problems such as radial artery occlusion (RAO), hemorrhage, spasm, and so on, is now considered the standard procedure for cardiac catheterization. The aim of the study is to present the distal transradial access (d-TRA) as a possible promising novel technique in the field of cardiac coronary interventions comparing it to the standard conventional TRA using primary and secondary endpoints, exploring its benefits and drawbacks as a new experience in Alexandria University. One hundred cases with variable indications for coronary interventions were randomized to two arms using systematic random sampling method, coronary interventions in the first one were done via d-TRA (50 patients) and in the second arm via conventional TRA group (50 patients). Results Technically, there were highly statistically significant differences between the two arms in favor of TRA regarding procedural success, number of punctures taken, Access time, Total procedural time, vasodilator used, and crossover to another access site; meanwhile safety profile parameters have showed statistically significant differences in favor of d-TRA regarding post-operative hematoma, AV fistula, post-operative pain and compression time, and there were no statistically significant differences regarding RAO although it occurred more in TRA group. Conclusions In the realm of cardiac intervention, the distal radial approach is a promising technique. When compared to TRA, we found it to be a viable and safe method for coronary angiography and interventions and it could be a real option for the interventionists in the near future, with a lower risk of radial artery blockage and no significant differences in wrist hematoma and radial artery spasm. The success rate of d-TRA is proportional to the steepness of the operator's learning curve and the quality of the examples chosen.

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Access-site hematoma in distal and conventional transradial access: a randomized trial

Cited by 13 publications

References 33 publications

Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta‐analysis

Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta‐analysis

Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis

Distal radial approach between theory and clinical practice.. Time to go distal!

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