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Limitations of successive transradial approach in the same arm: the Japanese experience
1Cardiovascular Division, Kitakyushu City Yahata Hospital, Fukuoka, Japan. sakai@radialist.com
Insights
The transradial approach (TRA) allows multiple radial artery cannulations. Repeated TRA procedures increase dropout rates, mainly due to radial artery narrowing or occlusion.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- The transradial approach (TRA) is widely used for cardiac procedures.
- The safety and feasibility of repeated cannulations of the same radial artery are not well-established.
Purpose of the Study:
- To determine the maximum number of times a single radial artery can be cannulated via TRA without significant complications.
- To investigate the factors contributing to failure in repeated TRA procedures.
Main Methods:
- Retrospective analysis of 1,438 transradial procedures in 812 patients between 1997 and 1999.
- Data collected on patient demographics, sheath size, number of TRA attempts, and reasons for failure.
- Dropout rates and complication frequencies were analyzed based on the number of successive TRA procedures.
Main Results:
- Dropout rates increased with successive TRA attempts, particularly in women (7.9% by the second attempt).
- Radial artery narrowing or occlusion was the primary cause of TRA failure (90% of 62 failures).
- A fifth TRA procedure was feasible in 70% of men and 50% of women, indicating potential for multiple uses.
Conclusions:
- Repeated transradial artery cannulations are feasible but associated with increasing dropout rates.
- Vessel narrowing and occlusion are the main complications limiting repeated TRA procedures.
- Careful patient selection and monitoring are essential for optimizing outcomes in patients undergoing multiple TRA procedures.
Abstract:
The transradial approach (TRA) has been used for diagnostic and interventional cardiology. It has not previously been determined how many times the same radial artery can be cannulated without complications. A total of 812 patients (502 men and 310 women) underwent angiography or angioplasty via the TRA between 1997 and 1999 at our institution with a total of 1,438 procedures. Sheaths were 5 (55%) or 6 Fr (45%). Dropout rates of 3.5% and 7.9% were found at the second TRA attempt in the men and the women, respectively. Of the 62 TRA failures, 56 (90%) were due to narrowing or occlusion of the radial artery after the previous TRA procedure. A third TRA procedure was possible in 90% of the men and 80% of the women. A fifth TRA procedure was possible in 70% of the men and 50% of the women. The dropout rates for TRA increased as successive punctures were performed. This was primarily due to vessel narrowing and occlusion occurring as a function of multiple punctures.
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