Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide

Coghill, Emma M; Johnson, Timothy A.; Morris, Russell E.; Megson, Ian L.; Leslie, Stephen J

doi:10.4330/wjc.v12.i1.26

Cited by 23 publications

(15 citation statements)

References 44 publications

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“…RAS is one of the most frequent complications in cardiac catheterization[ 29 , 30 ] and can be caused by mechanical stimulation by guide wires or catheters and increasing catecholamine levels, which are induced by pain and discomfort[ 28 ]. In previous systematic reviews, additional drugs, such as local anesthetics and vasodilatory medications, reduced RAS[ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

Izumida

Watanabe

Yoshida

et al. 2021

WJC

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BACKGROUND The traditional radial approach (RA) is recommended as the standard method for coronary angiography (CAG), while a distal RA (DRA) has been recently used for CAG. AIM To assess the efficacy and safety of the DRA vs RA during CAG. METHODS The following databases were searched through December 2020: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included. The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm (RAS) and radial artery occlusion (RAO). Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Three randomized control trials and 13 registered trials were identified. The two approaches showed similar successful cannulation rates [risk ratio (RR) 0.90, 95% confidence interval (CI): 0.72-1.13]. The DRA did not decrease RAS (RR 0.43, 95%CI: 0.08-2.49) and RAO (RR 0.48, 95%CI: 0.18-1.29). Patients with the DRA had a shorter hemostasis time in comparison to those with the RA (mean difference -6.64, 95%CI: -10.37 to -2.90). The evidence of certainty was low. CONCLUSION For CAG, the DRA would be safer than the RA with comparable cannulation rates. Given the limited data, additional research, including studies with standard protocols, is necessary.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

Izumida

Watanabe

Yoshida

et al. 2021

WJC

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“…14 On the other hand, radial artery spasm, radial artery thrombosis, and hematoma are among the common complications of TRCA. 19 Other rare complications of radial artery cannulation include dissection, pseudoaneurysm formation, infection, and perforation. 19 Studies regarding pain during coronary angiography are commonly associated with analgesics and anesthetic techniques.…”

Section: Discussionmentioning

confidence: 99%

“…19 Other rare complications of radial artery cannulation include dissection, pseudoaneurysm formation, infection, and perforation. 19 Studies regarding pain during coronary angiography are commonly associated with analgesics and anesthetic techniques. 9,10 Radial artery spasm has been extensively researched and is usually associated with procedure diffi culty and procedure failure, and the incidence is around 4-20%.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of post-procedural pain and associated factors experienced after transradial coronary angiography

Gül¹,

Açar²,

Karabulut³

et al. 2021

Cor Vasa

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V moderní kardiologické praxi představuje koronarografi e základní diagnostický a terapeutický výkon. Díky svým mnoha přednostem se dnes místo femorálního přístupu používá převážně přístup radiální. Někteří pacienti si však po výkonu stěžují na bolest v oblasti radiální tepny. Starší studie se touto komplikací příliš nezabývaly. Cílem naší studie bylo stanovit prevalenci bolesti v oblasti radiální tepny po koronarografi ckém vyšetření s radiálním přístupem a určit faktory ovlivňující míru bolesti po tomto výkonu. Metody: Do této průřezové studie bylo zařazeno celkem 100 po sobě následujících pacientů, u nichž bylo v období mezi lednem 2015 a lednem 2016 provedeno elektivní koronarografi cké vyšetření s radiálním přístupem ± perkutánní koronární intervence. Po výkonu byli pacienti dotazováni na přítomnost obtěžující bolesti v předloktí, zvláště v oblasti zápěstí. Intenzita bolesti se hodnotila pomocí verbální stupnice. Pacienti byli rozděleni do skupin s časně pociťovanou bolestí (dvě hodiny po výkonu) a s dlouhodoběji pociťovanou bolestí (měsíc po výkonu); jejich údaje byly následně analyzovány. Výsledky: Bolest v časné fázi (po dvou hodinách) uvedlo 55 pacientů, zatímco na dlouhodobější bolest ještě měsíc po výkonu s radiálním přístupem si stěžovalo 26 pacientů. Nezávislými prediktory bolesti byli muži operatéři (OR = 3,386, 95 % CI 1,484-7,725; p = 0,004) a zkušenosti operatéra (OR = 4,147; 95% CI 1,637-10,506; p = 0,003). Na druhé straně nezávislými prediktory dlouhodoběji pociťované bolesti v oblasti radiální tepny byly nižší věk pacienta (OR = 0,955; 95% CI 0,915-0,966; p = 0,032) a zkušenosti operatéra (OR = 3,947; 95% CI 1,547-10,047; p = 0,004). Závěr: Bolest po koronarografi ckém vyšetření s radiálním přístupem není nijak výjimečná. Nezávislými prediktory bolesti po tomto výkonu jsou zkušenosti a pohlaví operatéra a věk pacienta.

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“…In randomized trials, RAO incidence ranged up to 10%[ 5 ]. However, in daily clinical practice RAO frequency is much higher[ 4 , 14 - 16 ]. Radial artery patency should be routinely checked before discharge of any patient who has undergone coronary angiography via transradial access[ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Radial artery obstruction (RAO) is a frequent complication of coronary angiography performed via transradial access[ 4 ]. RAO may prevent radial artery access for future coronary angiography or as a conduit for coronary artery bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

Patent hemostasis of radial artery: Comparison of two methods

Kyriakopoulos¹,

Xanthopoulos²,

Papamichalis³

et al. 2021

WJC

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BACKGROUND Radial artery obstruction is the most common complication of coronary angiography performed via transradial access. Patent hemostasis can significantly reduce the risk of radial artery occlusion. Previous studies utilized sophisticated methods to evaluate radial artery patency. Simplified and easily applicable methods for successful patent hemostasis are currently lacking. AIM To determine which method (pulse oximeter vs the traditional radial artery palpation) is better to achieve patent hemostasis. METHODS This prospective, single center study included 299 consecutive patients who underwent coronary angiography or percutaneous coronary intervention between November 2017 and July 2019. Patients less than 18 years old, with a history of radial artery disease, or no palpable artery pulse were excluded from the study. Patients were randomly assigned to two groups. In the first group, radial artery flow was assessed by palpation of the artery during hemostasis (traditional method). In the second group, radial artery patency was estimated with the use of a pulse oximeter. Two different compression devices were used for hemostasis (air chamber and pressure valve). The primary study endpoint was the achievement of successful patent hemostasis. RESULTS The two groups (pulse oximeter vs artery palpation) had no significant differences in age, sex, body mass index, risk factors, or comorbidities except for supraventricular arrhythmias. The percentage of patients with successful patent hemostasis was significantly higher in the pulse oximeter group (82.2% vs 68.1%, P = 0.005). A lower percentage of patients with spasm was recorded in the pulse oximeter group (9.9% vs 19.0%, P = 0.024). The incidence of local complications, edema, bleeding, hematoma, vagotonia, or pain did not differ between the two groups. In the multivariate analysis, the use of a pulse oximeter (OR: 2.35, 95%CI: 1.34-4.13, P = 0.003) and advanced age (OR: 1.04, 95%CI: 1.01-1.07, P = 0.006), were independently associated with an increased probability of successful patent hemostasis. The type of hemostatic device did not affect patent hemostasis ( P = 0.450). CONCLUSION Patent hemostasis with the use of pulse oximeter is a simple, efficient, and safe method that is worthy of further investigation. Larger randomized studies are required to consider its clinical implications.

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Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide

Cited by 23 publications

References 44 publications

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

Prevalence of post-procedural pain and associated factors experienced after transradial coronary angiography

Patent hemostasis of radial artery: Comparison of two methods

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