Comparison of Diagnostic Accuracy of Digital Plethysmography Versus Duplex Ultrasound in Detecting Radial Artery Occlusion After Transradial Access

Pancholy, Samir; Patel, Viral; Pancholy, Shivam A; Patel, Aman; Patel, Gaurav; Shah, Sanjay; Patel, Tejas

doi:10.1016/j.carrev.2020.07.025

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…Symptoms indicating RAO, such as pain at the site of the thrombosis, paresthesia, and decreased limb function, are only present in a minority of cases, accounting for approximately 0.2% of patients. Hand ischemia due to RAO occurs exclusively in individuals with insufficient collateral circulation, mostly on account of anatomic variations [14].…”

Section: Rao Pathophysiologymentioning

confidence: 99%

“…While the modified reverse Barbeau's test, similar to the modified Allen's test, has been, until now, used as a method to clinically assess the adequacy of the ulnar artery's collateral flow before the radial artery's catheterization, in recent randomized controlled trials (RCTs), the effectiveness of this method has been compared to that of Doppler ultrasonography (USG) in detecting RAO. Important findings indicate that there is no significant difference in the efficacy of the two methods [14][15][16].…”

Section: Rao Diagnosismentioning

confidence: 99%

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Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Tsigkas,

Papanikolaou,

Apostolos

et al. 2023

JCDD

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Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.

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Section: Rao Pathophysiologymentioning

confidence: 99%

Section: Rao Diagnosismentioning

confidence: 99%

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Tsigkas,

Papanikolaou,

Apostolos

et al. 2023

JCDD

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“…Doppler ultrasonography (DUSG) is widely considered the gold standard for assessing RAO following TRA; however, digital plethysmography, using a modified reverse Barbeau’s test (MRBT), is more affordable and less time-consuming [ 40 - 41 ]. Although MBRT has demonstrated near-equivalency to DUSG in recent RCTs, operator error using the former assessment technique may have led to misinterpretation of RAO, for example, categorizing a true RAO as patent [ 42 - 43 ]. The laser Doppler scan is a novel, non-invasive method that may allow rapid diagnosis of RAO; however, this is not available in our setting [ 26 , 41 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

Seecheran,

Leyva Quert,

Seecheran

et al. 2024

Cureus

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Introduction: This retrospective study investigated the effectiveness and safety of left distal transradial access (LDTRA) in patients with cardiovascular disease in Trinidad undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Method: Procedural parameters, including technical success and safety outcomes such as vascular complications and radial artery occlusion (RAO), were assessed in 111 consecutive patients undergoing CAG or PCI from January 2023 to June 2023 at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Eighty-eight patients underwent LDTRA, while 23 received left transradial access (LTRA). Results: There was no difference in procedural success with LDTRA compared to LTRA, 90.9% vs. 100%, p -value 0.202, non-significant (ns). LDTRA was associated with shorter fluoroscopy times (8.4 ± 6.8 minutes vs. 12.4 ± 7.7 minutes, p -value = 0.02), procedural duration (26.7 ± 18 minutes vs. 35.8 ± 20 minutes, p -value = 0.04), and hemostasis time (142 ± 41 minutes vs. 186 ± 44 minutes, p -value < 0.05). There were no significant differences in procedural-related complications (8% for LDTRA vs. 4.3% for LTRA, p -value = 0.476, ns). There were no reported cases of RAO. In the subgroup of patients with prior coronary artery bypass grafting (CABG), the fluoroscopy and procedure times were similar for both access sites; however, LDTRA was associated with a shorter hemostasis time (128 ± 30 minutes vs. 194 ± 39 minutes, p -value = 0.01). Conclusions: LDTRA is effective and safe for coronary procedures and is associated with a shorter hemostasis time. This study may prove clinically pertinent in a limited-resource Caribbean setting.

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“…The gold standard diagnostic method is the radial artery ultrasound, which enables the evaluation of the blood flow in the radial artery, detection of any damage to the arterial wall, measurement of the artery’s diameter and diagnosis of any other complication. The most recent, more sophisticated and operator-independent diagnostic method that can evaluate radial artery perfusion following transradial catheterization is laser perfusion imaging (LPI), although it is not widely available and requires more specialized hardware and software than ultrasound [ 11 , 21 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Section: Introductionmentioning

confidence: 99%

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

Didagelos,

Pagiantza,

Papazoglou

et al. 2024

JCM

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Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05–2.83)), (ii) access site cross-over (aOR = 4.33 (1.02–18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00–1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40–4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28–4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29–20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01–3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70–40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06–0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96–0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31–1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42–14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67–32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46–9.87)), either pain (aOR = 2.93 (1.05–8.15)) or numbness (aOR = 4.66 (1.17–18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04–0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.

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Comparison of Diagnostic Accuracy of Digital Plethysmography Versus Duplex Ultrasound in Detecting Radial Artery Occlusion After Transradial Access

Cited by 6 publications

References 17 publications

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

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

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