Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Burzotta, Francesco; Mariani, Luca; Trani, Carlo; Coluccia, Valentina; Brancati, Marta Francesca; Porto, Italo; Leone, Antonio Maria; Niccoli, Giampaolo; Tommasino, Antonella; Tinelli, Giovanni; Mazzari, Mario Attilio; Mongiardo, Rocco; Snider, Francesco; Schiavoni, Giovanni; Crea, Filippo

doi:10.1016/j.ijcard.2012.05.017

Cited by 33 publications

(37 citation statements)

References 14 publications

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“…Other complications, such as artery laceration (4) , artery perforation (41) , granuloma (42) , mycotic aneurysm, arterial dissection, compartment syndrome, and limb ischemia (43) were reported in the selected publications, but due to their rare presentation they were only mentioned in the definitions of the complications evaluated or were reported in review studies as rare occurrences.…”

Section: Discussionmentioning

confidence: 99%

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo

Reich

Rabelo‐Silva

Santos

et al. 2018

Rev. Gaúcha Enferm.

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Objective:To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories.Methods: Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. Results:One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. Resultados: Fueron incluidas 128 publicaciones que permitieron mapear los contextos de estudio de las complicaciones, la ocurrencia de acuerdo con las vías, así como la comprensión del diagnóstico y manejo clínico. Como síntesis del análisis se identificó tres categorías temáticas: Complicaciones, Factores predictores y Diagnóstico/tratamiento. Conclusion Conclusión:Las complicaciones en el sitio del acceso vascular son de ocurrencia variable de acuerdo con la vía de acceso utilizada. El conocimiento de los factores que están presentes en la ocurrencia de estos eventos puede auxiliar en el reconocimiento temprano, planeamiento y control de la atención implementados.Palabras clave: Procedimientos endovasculares. Hematoma. Hemorragia. Atención al paciente.

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Section: Discussionmentioning

confidence: 99%

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo

Reich

Rabelo‐Silva

Santos

et al. 2018

Rev. Gaúcha Enferm.

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“…12 It is important to recognize the early signs and symptoms of compartment syndrome, which include tension upon palpation, acutely worsening pain, swelling, decreased sensation, and decreased motor function. The hand contains 10 muscle compartments; intracompartmental pressures of 15 to 25 mmHg have been suggested as the threshold for diagnosis in a tense swollen hand, although a reference standard for hand compartment syndrome does not yet exist.…”

Section: Discussionmentioning

confidence: 99%

Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

Jue¹,

Karam²,

Mejía³

et al. 2017

Texas Heart Institute Journal

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T he transradial approach to percutaneous coronary intervention (PCI) has lower rates of bleeding and vascular sequelae than does the femoral approach. Compartment syndrome of the forearm is a rare vascular sequela associated with radial access. We describe an unusual case of compartment syndrome of the hand without involvement of the forearm. Case ReportIn September 2015, a 64-year-old, right-handed man with a medical history of hypertension and end-stage renal disease (on hemodialysis) presented for elective outpatient cardiac catheterization. He had a systolic blood pressure (BP) of 190 mmHg. The patient's body mass index was 17.6 kg/m 2 (weight, 52 kg; height, 1.7 m). He had fair cardiac functional capacity and normal left ventricular function (ejection fraction, 0.55) on echocardiography.The patient's preprocedural laboratory values included an international normalized ratio of 1.0, a prothrombin time of 10.9 s, a baseline hemoglobin level of 9.1 g/dL, and a platelet count of 202,000/µL. He was given 325 mg of aspirin on the morning of the procedure.We attained, on the second attempt, right radial artery access with use of the frontwall (bare-needle) technique, and we inserted a 5F hydrophilic sheath 10 cm in length. Intra-arterial verapamil (5 mg) and intravenous unfractionated heparin (UFH) (5,000 U) were given at this point. Diagnostic cardiac catheterization revealed a mild stenosis involving the distal left main coronary artery (LMCA). The first obtuse marginal branch of the left circumflex coronary artery was a moderate-caliber vessel with a 90% eccentric stenosis. The sheath was upsized to 6F, and a 6F extra-backup guiding catheter engaged the LMCA without incident. The patient was given an additional 7,000 U of UFH, which resulted in an activated clotting time of 413 s. We successfully performed PCI of the obtuse marginal branch, using 2 drug-eluting stents. There was a good angiographic result-Thrombolysis in Myocardial Infarction-3 flow and no evidence of dissection. After the procedure, we gave the patient a 600-mg loading dose of clopidogrel.Upon completion of the procedure, we removed the right radial arterial sheath and placed an air-filled, transradial vascular hemostasis band over the access site. A small hematoma was noted proximal to the wristband, so a second vascular band was placed over that area. Pre-and postprocedural Barbeau tests with use of combined plethysmography and pulse oximetry recordings revealed normal findings consistent with patent radial and ulnar arteries. The patient was admitted to the inpatient medical service for post-PCI monitoring.Two hours later, nurses reported substantial bleeding upon initial deflation of 3 cc of air from the wristband, which was immediately reinflated per protocol. How-

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“…Yet, progressive miniaturization of materials and evolution of wiring techniques may currently allow to tackle the majority of CTO by 6 F guiding catheters [4]. Moreover, in the hand of expert TRA operators, bilateral radial access and appropriate guiding catheter selection and manipulation allows to have an excellent back-up from the guiding catheter [4]. In the present study we report on the experience earned in the last years by dedicated trans--radial operators operating in a high volume TRA centre [2].…”

Section: Discussionmentioning

confidence: 99%

“…Other types of instrumental investigations were eventually performed if deemed necessary. Vascular complications were defined as any vascular damage documented by specific instrumental investigations [2,4].…”

Section: Vascular Complications and Clinical Outcomementioning

confidence: 99%

Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists

et al. 2013

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Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Cited by 33 publications

References 14 publications

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo

Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists

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