Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures

Abstract

ObjectivesLittle is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity dysfunction after TR-PCP.MethodsTwo independent, trained investigators searched MEDLINE, EMBASE and CENTRAL for eligible studies published before 1 January 2015. Also, they hand-searched the conference proceedings of the annual scientific sessions of the American College of Cardiology, the American Heart Association, European Society of Cardiology, and the Trans-catheter Cardiovascular Therapeutics. Inclusion criteria were cohort studies and clinical trials discussing the incidence of access-site complications and upper extremity function after transradial percutaneous coronary intervention (TR-PCI) and/or transradial coronary angiography (TR-CAG) as endpoints.Results176 articles described access-site complications. The incidence is up to 9.6 %. Fourteen articles described upper extremity dysfunction, with an incidence of up to 1.7 %. Upper extremity dysfunction was rarely investigated, hardly ever as primary endpoint, and if investigated not thoroughly enough.ConclusionUpper extremity dysfunction in TR-PCP has never been properly investigated and is therefore underestimated. Further studies are needed to investigate the magnitude, prevention and best treatment of upper extremity dysfunction. Optimising TR-PCP might be achieved by using slender techniques, detection of upper extremity dysfunction and early referral to a hand rehabilitation centre.Electronic supplementary materialThe online version of this article (doi: 10.1007/s12471-015-0747-9) contains supplementary material, which is available to authorized users. This supplementary file contains References 51–202.

Upper Extremity Function after Transradial Percutaneous Coronary Intervention Short-Term Interim Results of the ARCUS Study

“…There has never been such an extended and all-round study grasping all facets forming upper extremity function after transradial PCI. The highly sensitive binary score, composed by hand specialists, is a first attempt to measure the overall function of the upper extremity after transradial PCI [9] . We think that it may have been too sensitive and overestimated the actual and clinically relevant upper extremity dysfunction.…”

“…After local anaesthesia of the wrist with a subcutaneous injection of 2 % lidocaine, the radial artery was punctured with an introducer needle (Terumo Medical Corporation, Tokyo, Japan) using a modified Seldinger technique [12,13] . After introduction of the wire, the introducer needle was removed and a 6F introducer sheath (Terumo) was inserted [9] . Heparin, 100IU/KG and a mixture of verapamil, 5 mg, nitroglycerin, 200 μg, and 10 ml of saline solution were administered.…”

“…However, the precise effects of transradial procedures on the upper extremities function are unknown. The few published studies lack clear definitions of outcomes and systematic protocols and report inconsistent relationships between access-site complications and upper extremity function [6][7][8][9] . Several important factors combined contribute to the normal function of the upper extremities, including intact anatomy, blood supply and lymphatic drainage, muscle strength, range of motion, coordination and sensibility.…”

“…Upper extremity function has been defined as "The physiological capacity in which the patient can use an anatomically intact upper limb in everyday activities" [9] . Procedural complications may be the source of Upper Extremity Dysfunction (UED).…”

Effects of radial versus femoral artery access in patients with acute myocardial infarction: A large centre prospective registry

“…Myocardial infarction (MI) and PCI-related bleeding have been strongly associated with early and late mortality [5–9]. The use of radial access has been demonstrated to be feasible in the ACS setting and, compared with femoral access, a reduction in vascular complications and bleeding has been suggested [10, 11]. Whether this evident reduction in access-site bleeding may also have a positive impact on prevention of further cardiovascular events remains to be defined.…”