Vascular Communications of the Hand in Patients Being Considered for Transradial Coronary Angiography

Greenwood, Michael J.; Della-Siega, A.; Fretz, Eric; Kinloch, David; Klinke, Peter; Mildenberger, Richard R.; Williams, M. B.; Hilton, David

doi:10.1016/j.jacc.2005.07.058

Cited by 81 publications

(47 citation statements)

References 23 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The radial artery is larger than the ulnar in 51% of patients. 43 Greenwood et al 19 found that a longer Allen test time is associated with larger radial and smaller ulnar artery size.…”

Section: Sheath Sizementioning

confidence: 99%

“…16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

176

133

View full text Add to dashboard Cite

T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

show abstract

“…The radial artery is larger than the ulnar in 51% of patients. 43 Greenwood et al 19 found that a longer Allen test time is associated with larger radial and smaller ulnar artery size.…”

Section: Sheath Sizementioning

confidence: 99%

mentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

176

133

View full text Add to dashboard Cite

show abstract

“…Intracardiac thrombus formation is a rare complication during angiography. Generally, local vascular complications occur less frequently with the radial artery access and even radial access is associated with better outcomes (2,3). Nevertheless, there is no information on other major complications in this arterial access way.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Accident and Mesenteric Ischemia Following Diagnostic Coronary Angiography

Nikdoust¹,

Eghbalnezhad²

2015

Arch Cardiovasc Imaging

View full text Add to dashboard Cite

Introduction: Coronary angiography can be complicated by some major complications such as stroke. Case Presentation: We describe a patient who presented with hemiparesia. He had undergone coronary angiography on his right and left coronary arteries as well as his left ventricle (LV) via the radial artery access 10 days earlier using a 6-French Tiger catheter. Transthoracic echocardiography showed a large (36 × 25 mm) inhomogeneous mobile mass attached to the apicoseptal LV segment. His serum protein S was low (60% [normal = 77 -140%]), while his protein C was normal and lupus anticoagulant was negative. During hospitalization, he developed severe abdominal pain, for which mesenteric ischemia was diagnosed. First, he underwent surgery for the resection of the infarcted intestinal segments. Then cardiac surgery was done to remove the mass. The mass was diagnosed as a thrombus. After the surgery, the general condition of the patient deteriorated and blood culture showed acinetobacter septicemia. Finally, he died due to sepsis. A review of his coronary angiography revealed that after the contrast media had left the LV, there was still dye at the contact point between the tip of the catheter and the LV, which was compatible with the location of thrombus formation. Conclusions: Trauma induced by the tip of the catheter at the contact location with the LV wall in a patient with mild hypercoagulable state accounted for intracardiac thrombosis formation and its embolization to the brain and intestines.

show abstract

“…There are some reports on digital ischemia requiring amputation in patients with a negative AT [18,19]. Greenwood et al have investigated the effect of RA occlusion in patients previously screened by AT [20]. In this study RA was occluded for 30 minutes and patients were screened for hand ishaemia, UA flow and venous lactate level.…”

Section: Discussionmentioning

confidence: 99%