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The pulseless radial artery in transradial catheterization: challenges and solutions
Analkumar Parikh1, Ian C Gilchrist1
1Interventional Cardiology, Pennsylvania State University, College of Medicine, Penn State Heart & Vascular Institute, M.S. Hershey Medical center, Hershey, PA, USA.
Insights
For absent radial pulse during cardiac catheterization, alternative forearm access methods can prevent high-risk femoral artery access. Prompt diagnosis and treatment of radial artery occlusion are crucial for preserving blood flow.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Medical Imaging
Background:
- Absent radial pulse before cardiac catheterization indicates a need for higher-risk arterial access.
- Radial artery access offers benefits but is threatened by potential occlusion.
- Existing solutions can mitigate risks associated with hazardous arterial access.
Purpose of the Study:
- To provide an approach for forearm access when a palpable radial pulse is absent.
- To emphasize the importance of preserving radial artery flow.
- To highlight alternative forearm access sites when radial occlusion is persistent.
Main Methods:
- Literature review of forearm access, including case series and trials.
- Discussion of ultrasound's role in safe access and procedural planning.
- Expert opinion on managing absent radial pulse during cardiac catheterization.
Main Results:
- The literature provides a framework for evaluating forearm access challenges.
- Ultrasound is significant for safe access and planning.
- Alternative forearm access can avoid femoral artery cannulation.
Conclusions:
- Preserving radial artery flow is a primary objective.
- Alternative forearm access strategies are vital when radial pulse is absent.
- Improved techniques, adjunctive therapies, and devices will enhance outcomes.
Abstract:
Introduction: An absent radial pulse prior to cardiac catheterization is an ominous finding as it portends the need for higher-risk arterial access. Solutions exist that can avoid the use of more hazardous access. Given the benefits of the radial artery access, it is essential to prevent radial artery occlusion, to diagnose acute occlusion at the time of hemostasis so it can be treated, and understand alternatives for access that exists in the lower forearms if the radial occlusion is recalcitrant. Ultrasound plays a significant role in safe access and procedural planning. It should be a skill embraced by all operators. Future devices will be improved for shallow vessel access. Better knowledge of access techniques and adjunctive therapies will work synergistically to improve outcomes in the years ahead.Areas covered: Literature review on forearm access is composed of small case series and underpowered trials but does provide a framework for evaluating the problem.Expert opinion: The objective of this paper is to give an approach to tackle forearm access when there appears to be no palpable radial pulse. Preservation of radial flow is paramount while alternative forearm means to vascular access may help avoid the need to access the femoral artery.
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