Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Abstract

Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.

Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial

“…Although most RAO is asymptomatic, an occluded radial artery limits the further use of the radial artery for the repeated catheterization approach and the conduits in patients undergoing coronary artery bypass graft and radial arteriovenous fistula in renal insufficiency in the future. Therefore, preventing and managing RAO is very important [22]. However, the incidences of RAO accrossing studies were inconsistent.…”

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

“…As stated above, RAO is the most frequent complication of forearm transradial catheterization, with an overall incidence ranging from 0.8 to 38% depending on several factors [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. RAO incidence is also reported to be lower in patients undergoing PCIs (4.0–4.5%) versus those only having angiography performed (5.9–8.8%) [ 16 , 18 ].…”

“…RAO is the most common complication of transradial catheterization, with a varying overall rate ranging from 0.8 to 38% (with a mean incidence of about 5–10%) in the published literature. This variability can be explained by differences in the timing of evaluations; the methods used for diagnosis (pulse palpation vs. ultrasound) and the periprocedural anticoagulation; and the evolution of the puncture technique (ultrasound-guided), the equipment (lower-profile sheaths and catheters) and hemostatic protocols (patent hemostasis, the simultaneous pressure of both radial and ulnar arteries during hemostasis) [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Moreover, RAO incidence differs when evaluated after a diagnostic coronary angiography only (5.9–8.8%) versus after a PCI (4.0–4.5%) [Rashid2016, Hahalis2017].…”

“…The gold standard diagnostic method is the radial artery ultrasound, which enables the evaluation of the blood flow in the radial artery, detection of any damage to the arterial wall, measurement of the artery’s diameter and diagnosis of any other complication. The most recent, more sophisticated and operator-independent diagnostic method that can evaluate radial artery perfusion following transradial catheterization is laser perfusion imaging (LPI), although it is not widely available and requires more specialized hardware and software than ultrasound [ 11 , 21 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…These can be divided into pre-procedural (non-modifiable), procedural (modifiable) and post-procedural (also modifiable). Several studies have tried to accurately identify them and describe methods, techniques and materials to overcome them in order to reduce RAO rates; however, there is conflicting evidence for some of them [ 11 , 16 , 21 , 30 , 44 ].…”