Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention

Bernát, Ivo; Aminian, Adel; Pancholy, Samir; Mamas, Mamas A.; Gaudino, Mario; Nolan, James; Gilchrist, Ian C.; Saïto, Shigeru; Hahalis, George; Ziakas, Antonio; Louvard, Yves; Montalescot, Gilles; Sgueglia, Gregory A.; Leeuwen, Maarten A.H. van; Бабунашвили, А. М.; Valgimigli, Marco; Rao, Sunil V.; Bertrand, Olivier

doi:10.1016/j.jcin.2019.07.043

Cited by 143 publications

(162 citation statements)

References 56 publications

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“…The very low incidence of complete radial artery occlusion in our study (0.4%) stems from our long-standing and well-established standardized operating protocol, which is based on the concept of optimizing the approach in RAO prevention. 5 …”

Section: Discussionmentioning

confidence: 99%

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Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test

Jirouš

Bernát

Slezák

et al. 2020

European Heart Journal Supplements

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The transradial approach is recommended as a first choice in coronary catheterizations and interventions, for among other reasons, the reduction in the number of local complications. A head-to-head comparison of the reverse Barbeau test (RBT) and duplex ultrasonography (DUSG) for the detection of post-procedural radial artery patency and occlusion has not yet been evaluated. In 500 patients from our same-day discharge program (age 65 ± 9.4 years, 148 women), radial artery patency and occlusion, compression time, haematomas, and other local complications were evaluated. Radial artery patency was confirmed in 495 patients (99.0%), and complete radial artery occlusion (RAO) was detected in 2 (0.4%) patients using both methods. In 3 patients (0.6%), the RBT was negative, while incomplete RAO was detected by DUSG. Superficial haematomas (˃ 5 but ≤10 cm) were found in 27 (5.4%) patients. There were no other local complications. Detection of radial artery patency and occlusion using the RBT and DUSG was comparable. The incidence of RAO in our study was extremely low. Thanks to its simplicity, the RBT has the potential to be used as the first method of detection of radial occlusion after coronary catheterizations.

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Section: Discussionmentioning

confidence: 99%

“…This method is considered the gold standard for arterial flow assessment, and when there is a suspicion of an RAO then DUSG should be performed to confirm the finding. 5 …”

Section: Methodsmentioning

confidence: 99%

Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test

Jirouš

Bernát

Slezák

et al. 2020

European Heart Journal Supplements

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“…TRA for coronary diagnosis or revascularization procedure is progressively used worldwide since it is associated with lower bleeding and vascular complications than trans-femoral access [ 7 ]. However, specific complications of TRA exist; for instance, RAO can be observed in up to 13.7% of cases despite many precautionary measures [ 8 , 9 ]. Regarding the occurrence of RAO, its future use as an access site for CAG or PCI, a conduit for coronary bypass grafting, or for fistula formation in hemodialysis patients is limited.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention

Mori

Hirano

Yamawaki

et al. 2020

Journal of Interventional Cardiology

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Objectives. To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Background. Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported. Method. Overall, 137 patients (144 procedures) who underwent CAG or PCI using dTRA between September 2018 and February 2019 were investigated. These patients were classified into two groups: C (dTRA with conventional punctures; 76 patients, 79 procedures) and U (dTRA with ultrasound-guided punctures; 61 patients, 65 procedures) groups. Successful procedural rate, procedural outcomes, and complication rate during hospital stays were compared between the two groups. Results. The procedural success rate was significantly higher in the U group than in the C group (97% vs. 87%, P=0.0384). However, the rate of PCI, puncture time, total fluoroscopy time, the volume of contrast medium, the rate of access-site ecchymosis, and incidence of nerve disorder were similar between the two groups. Additionally, radial artery occlusion after the procedure did not occur in this study. Conclusion. The ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. However, there were no significant differences in puncture time and complication rate between the two procedures.

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“…Flow absence along with information about anatomy (curves, loops, etc.) is very important for future interventions [ 27 – 29 ]. However, the oximetry/plethysmography test is a simple and inexpensive bedside method.…”

Section: Discussionmentioning

confidence: 99%

“…However, the oximetry/plethysmography test is a simple and inexpensive bedside method. This method is highly sensitive and can be equally useful in assessing of the radial artery patency [ 6 , 7 , 16 , 18 , 29 ]. We found that rates of RAO by oximetry/plethysmography and duplex ultrasound were equal.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

Ognerubov

Sedaghat

Проваторов

et al. 2020

Journal of Interventional Cardiology

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Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

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Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention

Cited by 143 publications

References 56 publications

Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test

Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test

A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention

A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

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