The Effect of Transradial Coronary Catheterization on Upper Limb Function

Leeuwen, Maarten A.H. van; Mieghem, Nicolás M. Van; Lenzen, Mattie J.; Selles, Ruud W.; Hoefkens, Mirjam F.; Zijlstra, Felix; Royen, Niels van

doi:10.1016/j.jcin.2014.10.025

Cited by 30 publications

(31 citation statements)

References 38 publications

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“…1 For many patients undergoing diagnostic or interventional procedures, the shorter postprocedural monitoring, early ambulation, and less discomfort make TRA an attractive alternative to the transfemoral approach. 2 prohibitive lesion complexity or distance from the access site remain potential barriers to TRA uptake, along with concerns regarding major vascular complications and stroke. Nonetheless, in a number of studies of patients presenting with acute coronary syndromes, the estimated rates of major vascular complications occurring with TRA (hand ischemia, compartment syndrome, major bleeding) remain strikingly low, ~1.7% of cases, with stroke rates varying from 0.1% to 0.4%.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

et al. 2016

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Purpose: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions. Methods: A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud’s disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared. Results: FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12). Conclusion: The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.

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Section: Introductionmentioning

confidence: 99%

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

et al. 2016

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“…Yet, the trans-radial approach (TR) is a valuable alternative to the TF approach and has been shown to reduce access-site bleeding and vascular complications [11,12] and is possibly associated with better clinical outcomes in patients undergoing angioplasty. [13,14] Early ambulation, lower patient discomfort, also makes TR an attractive alternative to the TF approach [15]. For such reasons, the TR approach is now used not only in routine coronary procedures, but also in complex percutaneous coronary interventions, chronic total occlusion interventions and peripheral interventions [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Short and long-term outcomes of alcohol septal ablation with the trans-radial versus the trans-femoral approach

Sawaya

Louvard

Spaziano

et al. 2016

International Journal of Cardiology

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“…However, these end points were secondary in our study, and recent reports confirmed the lack of impact of radial catheterization on the upper limb function. 23 Radial spasm definition was prespecified in the study protocol according to accepted intravascular ultrasound consensus. 24 Still, radial spasm was evaluated only in the acute phase and the evidence of an image resembling spasm long after cannulation might be related with vessel remodeling.…”

Section: Limitationsmentioning

confidence: 99%

The Rotterdam Radial Access Research

Costa

Leeuwen

Daemen

et al. 2016

Circ: Cardiovascular Interventions

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Background-Radial artery wall might be damaged after cannulation for cardiac catheterization. We investigated structural changes of the radial artery wall after catheterization to understand whether these might predict radial pulsation loss or occlusion and local pain or functional impairment of the upper extremity. Methods and Results-Ninety patients underwent transradial coronary angiography or intervention and were scanned with a high-resolution 40-MHz ultrasound before cannulation and at 3 hours and 30 days after procedure. Acute injuries of the radial artery occurred in all patients: dissection and intramural hematoma were the most common. However, these phenomena did not predict loss of radial pulsation or occlusion, local pain, or functional impairment at 30 days. Overall, the radial artery lumen was significantly reduced distal to the puncture site. Radial artery intima and total wall thickness increased 3 hours after puncture and persisted at 30 days. Radial occlusion and pulsation loss were observed in 3.9% and 9.2% of patients, respectively, at 30 days. Smaller radial artery lumen at baseline increased the risk of radial pulsation loss at 30 days (odds ratio, 1.23; P=0.049). The number of radial puncture attempts predicted pulsation loss (odds ratio, 2.64; P=0.027), occlusion (odds ratio, 3.49; P=0.022), and symptoms (odds ratio, 2.24; P=0.05) at 30-day follow-up. Conclusions-After catheterization, radial artery puncture site is associated with increased intima and total wall thickness and with modest decrease of inner lumen diameter. Acute injuries of the vessel wall were ubiquitous, but contrary to repeated puncture attempts, did not seem to affect postprocedural radial occlusion or loss of pulsation.(Circ Cardiovasc Interv. 2016;9:e003129.

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The Effect of Transradial Coronary Catheterization on Upper Limb Function

Abstract: Upper limb function was not affected when coronary catheterizations and interventions were performed through the radial artery.

Cited by 30 publications

References 38 publications

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

Short and long-term outcomes of alcohol septal ablation with the trans-radial versus the trans-femoral approach

The Rotterdam Radial Access Research

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