Large pectoral haematoma post-transradial catheterisation: an unusual but avoidable complication

Sharma, Ajay; Rajvanshi, Satyam; Kumar, Tarun; Pandit, Neeraj

doi:10.1136/bcr-2017-221088

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…Smooth tips could be more friendly to the vessel wall than the original angle tips, especially when encountering tortuosity and loops. An angle tip contacting with the vessel wall increases the risk of dissection and perforation ( 9 , 10 , 17 ). Thanks to its preference for the main artery and a smooth tip, advancement of a knuckle guidewire becomes more efficient.…”

Section: Discussionmentioning

confidence: 99%

“…Another choice is an angle-tip 0.035-inch hydrophilic guidewire (Radifocus, Terumo, Japan) commonly used for its superiority in tortuosity and direction changes ( 8 ). However, it can glide into small side branches without appreciable resistance, increasing the risk of subintimal dissection and perforation ( 9 , 10 ). Sometimes a side branch mimics the main artery due to its lengthy and parallel course ( 7 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better Than Cure

Cao

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCurrent guidewires for transradial coronary angiography had defects of passage difficulty or branch injury. This study sought to investigate the safety and efficiency of a novel method of active knuckle-angle 0.035-inch hydrophilic guidewire in transradial coronary angiography.MethodsPatients undergoing a transradial coronary procedure in our team from August 2015 to June 2020 were retrospectively investigated. We compared the demographic and interventional characteristics of 1,457 patients receiving advancement of unmodified guidewires (Traditional group) and 1,322 patients receiving advancement of the knuckle guidewire (Knuckle group). Afterwards we included 239 patients and randomized them according to a random number table to either the unmodified or the knuckle guidewire to further confirm the efficiency and safety of knuckle guidewire advancement.ResultsIn the retrospective analysis, unwilling passage of guidewire into branches occurred more in the Traditional group than in the Knuckle group (9.5 vs. 0.08%, p < 0.001). Two patients in the Traditional group experienced guidewire-associated perforation. One patient was treated with covered stent for internal mammarian artery perforation, while the other was managed with compression for brachial branch perforation. In the randomized controlled study, unwilling passage of guidewire also occurred more in the Traditional group (10.8 vs. 1%, p < 0.001). Median duration of guidewire advancement from the sheath to aortic root significantly decreased from 33 seconds in the Traditional group to 21 seconds in the Knuckle group.ConclusionActive knuckle angle guidewire represented a novel method to prevent unwilling passage and associated perforation with efficiency improvement and a reduction in radiation exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better Than Cure

Cao

Zhang

et al. 2022

Front. Cardiovasc. Med.

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show abstract

“…Smooth tip could be friendlier to the vessel wall than original angle tip, especially when encountering tortuosity and loop. The angle tip contacting with vessel wall increases risk of dissection and perforation [9,10,17]. According to its preference for main artery and smooth tip, advancement of guidewire becomes more e cient.…”

Section: Discussionmentioning

confidence: 99%

“…However, anatomic variations of radial artery and S-shaped con guration of the subclavian-innominate-aorta axis often disabled J-tip 0.035-inch guidewire passage [6,7]. An angle tip 0.035-inch hydrophilic guidewire (Radifocus, Terumo, Japan) is commonly used for its superiority in tortuosity and direction change [8], which can glide into small side branches without appreciable resistance, heightening the risk of subintimal dissection and perforation [9,10]. Sometimes the branch is apparently mimicking the main artery due to its lengthy and parallel course [7,11].…”

Section: Introductionmentioning

confidence: 99%

Minimizing Guidewire Unwilling Passage and Related Perforation: Prevention is Better Than Cure

Cao

Zhang

et al. 2020

Preprint

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Background: Current guidewires for transradial coronary angiography had defects of passage difficulty or branch injury. This study sought to investigate the safety and efficiency of a novel method of active knuckle angle 0.035-inch hydrophilic guidewire in transradial coronary angiography.Methods: Patients who underwent a transradial coronary procedure from August 2015 to June 2020 were consecutively noted. Of them, 1457 patients were allocated into the Traditional group, while the following 1322 patients were allocated into the Knuckle group to investigate the safety. In addition, 239 patients were randomly divided to evaluate its efficiency. Results: Unwilling passage of guidewire into branches occurred more in Traditional group than in Knuckle group (9.5% vs. 0.08%, p<0.001). Of them, 2 patients experienced guidewire associated perforation in Traditional group. Covered stent was used for 1 patient with internal mammarian artery perforation, and the other was treated with compression for brachial branch perforation. Furthermore, duration of guidewire advancement from the sheath to aortic root significantly decreased in the Knuckle group (22.6±8.0s vs. 33.4±16.9s, p<0.001). Conclusions: Active knuckle angle guidewire was a novel method to prevent unwilling passage and associated perforation, which also improved the efficiency and reduced radiation exposure.

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Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature

Wang,

Wen,

Xie

et al. 2023

BMC Cardiovasc Disord

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Background Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening. Case presentation A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period. Conclusions Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.

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Large pectoral haematoma post-transradial catheterisation: an unusual but avoidable complication

Cited by 4 publications

References 6 publications

Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better Than Cure

Minimizing Guidewire Unwilling Passage and Related Perforation During Transradial Procedures: Prevention Is Better Than Cure

Minimizing Guidewire Unwilling Passage and Related Perforation: Prevention is Better Than Cure

Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature

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