Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Abstract

Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

“…The most widely used is the radial artery: it is easy to access, and it is not a terminal artery, so its possible occlusion will not compromise blood flow to the hand, which is also vascularized by the ulnar artery [44]. The presence of effective collateral circulation should always be verified with the Allen test [45].…”

Radial artery spasm: Should we worry?

“…Studies regarding complications associated with radial arterial lines identify a variety of issues (e.g., hematoma, pseudoaneurysm, infection, thrombosis, ischemia, neuropathy) with scarce consideration of RAS. [7][8][9][10] This speaks to the fact that, in its mildest (and most common) form, RAS is assumed to be a relatively transient phenomenon without lasting consequences. By way of example, consider the RAS commonly encountered after a few unsuccessful attempts at establishing a radial arterial line.…”

“…Les études concernant les complications associées aux cathéters de l'artère radiale identifient des problèmes variés (hématome, pseudoanévrysme, infection, thrombose, ischémie, neuropathie) et ne s'intéressent qu'assez peu au SAR. [7][8][9][10] Cela indique que dans sa forme la plus légère (et la plus fréquente), on suppose que le SAR est un phénomène relativement transitoire sans conséquence à long terme. À titre d'exemple, il suffit de penser aux SAR fréquemment observés après quelques tentatives infructueuses de mise en place d'un cathéter de l'artère radiale.…”

Critical hand ischaemia after transradial cardiac catheterisation: an uncommon complication of a common procedure

“…Profound circulatory failure, hypotension, and high-dose vasopressor therapy may increase the risk of hand ischaemia [15,18,19], although these conditions may not be applicable to the majority of patients undergoing transradial coronary interventions. Other factors, such as the number of puncture attempts, artery size, the composition of the catheter (teflon vs. polypropylene), catheter diameter, and female gender are even more controversial [18][19][20].…”