Ultrasound study of forearm arteries in patients undergoing cardiac catheterization, and assessment of predictors of arterial vessel caliber

Abstract

Background: The radial approach has been increasingly used worldwide for diagnostic and therapeutic cardiac catheterization. The radial artery caliber is one of the limitations of its use. The objective of this study was to describe the anatomy of the radial and ulnar arteries, as well as to develop a radial artery diameter prediction score using clinical and anthropometric criteria. Methods: Using vascular ultrasound with bilateral radial and ulnar artery measurements, 1,180 patients who underwent cardiac catheterization or angioplasty procedures were prospectively evaluated. Using the patients' variables, a radial artery diameter prediction score was developed in a cross-sectional fashion, using half of the sample. The score was validated with the half not used for deriving the model. Results: A total of 1,180 patients were evaluated. The mean internal diameter of the right and left radial arteries was 2.69±0.69mm and 2.53±0.64mm (p<0.01), and the mean internal diameter of the right and left ulnar arteries was 2.09±0.59mm and 2.10±0.60mm (p=0.76), respectively. The factors that positively correlated with arterial size were male sex, previous catheterization, height, weight, and body surface area. The risk score developed using clinical and anthropometric variables had unsatisfactory discriminatory capacity (c-statistics 0.64). Conclusion: The right radial artery is the largest forearm artery in most cases. Men and patients who had previously undergone catheterization have a larger mean radial artery diameter. The artery diameter prediction score has modest accuracy for clinical use. RESUMO -Introdução:A via de acesso transradial tem crescido em utilização mundialmente para cateterismo cardíaco diagnóstico e terapêutico. O calibre da artéria radial é um dos limitadores de seu uso. O objetivo deste estudo foi descrever a anatomia das artérias radiais e ulnares, bem como desenvolver um escore de predição de diâmetro da artéria radial, utilizando critérios clínicos e antropométricos. Métodos: Usando ultrassonografia vascular, com mensuração de artérias radiais e ulnares, bilateralmente, foram prospectivamente avaliados 1.180 pacientes, que foram submetidos a procedimentos de cateterismo cardíaco ou angioplastia. Usando as variáveis dos pacientes, foi transversalmente elaborado um escore de predição de diâmetro de artéria radial, utilizando-se metade da amostra. O escore foi validado com a metade da população não utilizada para a formulação do escore. Resultados: Foram avaliados 1.180 pacientes. O diâmetro interno médio das artérias radiais direita e esquerda foram 2,69±0,69mm e 2,53±0,64mm (p<0,01), e das artérias ulnares direita e esquerda foram 2,09±0,59mm e 2,10±0,60mm (p=0,76). Os fatores que se correlacionaram positivamente com o tamanho arterial foram sexo masculino, cateterismo prévio, altura, peso e área de superfície corporal. O escore de risco desenvolvido utilizando variáveis clínicas e antropométricas teve capacidade discriminatória não satisfatória (estatística-c 0,64). Conclusão: A artéria radial dire...

Effect of nitroglycerin on radial artery spasm and occlusion in transradial catheterizations performed in women

“…Evaluation of the size of the radial artery demonstrated that female sex is a predictor of arteries of smaller caliber. 12,13 The use of the pain criterion, despite being the most appropriate, may lead to a greater manifestation of pain in patients with arteries of caliber smaller than the material used, which may explain the higher incidence of RAS in women. The presence of circulating estrogen can also attenuate the effect of nitroglycerin, since estrogen has an important vasodilating role mediated by endogenous release of nitric oxide, normally maintaining a reduced vascular tone, with little response to the application of external nitrates.…”