Vascular Complications of Transradial Access for Cardiac Catheterization

Abstract

Transradial access has been increasingly adopted for cardiac catheterization. It is crucial for operators to recognize potential vascular complications associated with radial artery access. Prevention, early detection, and prompt treatment of vascular complications are essential to prevent serious morbidities. This review aims to raise awareness of transradial access vascular complications. Radial artery spasm is treated with intra-arterial verapamil and/or nitroglycerine. Hemorrhagic complications, such as perforation, hematoma, arteriovenous fistula, and pseudoaneurysm, are treated with prolonged compression. Patent hemostasis and adequate anticoagulation are used to prevent radial artery occlusion. Hand ischemia is a rare complication not associated with abnormal results of the Allen or Barbeau test, and can be treated with intra-arterial verapamil, IV heparin, and IV diltiazem. Finally, an attentive monitoring protocol for the timely detection of vascular complications should be implemented in daily practice.

A Concurrent Pseudoaneurysm and an Arteriovenous Fistula Following Percutaneous Radial Artery Access

“…Percutaneous access is the most common cause of iatrogenic PSA [ 5 ]. Risk factors contributing to the increased likelihood of PSA development include multiple puncture attempts, catheter infection, anticoagulation, vascular site infection, and large sheath size [ 3 , 5 ].…”

“…Frequently, these complications can be treated conservatively without requiring surgical intervention. PSAs often resolve with prolonged manual compression, correction of coagulopathy, or with thrombin injection [ 3 , 6 ]. AVFs rarely require surgical intervention and can be treated with transradial compression bands and expectant waiting [ 4 ].…”

“…The surgical indications for the resection of PSAs and AVFs are similar. Indications for PSAs include symptoms (i.e., pain), failure to resolve with conservative measures, or a diameter >3cm [ 3 ]. Indications for AVFs include limb ischemia and high-output heart failure [ 7 ].…”

“…The RIVAL trial found that over 90% of patients expressed a preference for repeating the transradial approach if needed, compared to 49% of patients who desired to repeat the transfemoral approach [ 2 ]. Complications, while rare, included radial artery spasm, non-coronary artery dissection, perforation, occlusion, arteriovenous fistula, pseudoaneurysm, compartment syndrome, and hand ischemia [ 3 ].…”

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

“…Transradial access is nowadays strongly preferred as the default access route for coronary procedures, coronary angiography and/or percutaneous coronary interventions (PCIs) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Nevertheless, it is widely acknowledged that its utilization is not devoid of challenges and complications, such as radial artery occlusion (RAO), arterial spasms, the perforation of the artery, forearm hematomas, bleeding at the puncture site, pseudoaneurysm formation, arterio-venous fistulas, nerve injury, sterile granulomas, eversion endarterectomies and skin necrosis [ 9 , 10 , 11 , 12 ].…”