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Published on: September 20, 2020
Radial Artery Access Complications: Prevention, Diagnosis and Management
Sumon Roy1, Mohamad Kabach1, Dhavalkumar B Patel1
1Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America.
Insights
The transradial approach for cardiac catheterization offers fewer access site complications than the transfemoral approach. However, vigilance for radial access site complications is crucial to prevent patient morbidity and mortality.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- The transradial approach (TRA) is increasingly used for cardiac and peripheral vascular procedures due to lower access site complication rates compared to the transfemoral approach (TFA).
- Growing utilization of TRA necessitates awareness of its specific access site complications, which can lead to significant morbidity and mortality.
- Heterogeneity in reporting and under-diagnosis contribute to challenges in understanding the true incidence and impact of radial access site complications.
Purpose of the Study:
- To review the incidence, clinical factors, and management strategies for radial access site complications.
- To emphasize the importance of physician awareness and vigilance in preventing these complications.
- To provide a comprehensive overview of complications associated with transradial access in cardiac catheterization.
Main Methods:
- Literature review of studies reporting on radial access site complications.
- Analysis of intraprocedural and post-procedural complications.
- Discussion of diagnostic and management strategies.
Main Results:
- Intraprocedural complications include spasm, catheter kinking, dissection, and perforation, potentially increasing procedure time and crossover rates.
- Post-procedural complications encompass radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, and nerve injury, leading to discomfort and limb dysfunction.
- Prompt evaluation and treatment are essential to mitigate long-term consequences of radial access site complications.
Conclusions:
- While TRA offers benefits, healthcare professionals must be vigilant for potential radial access site complications.
- Early recognition and comprehensive management are key to reducing morbidity associated with these complications.
- Understanding the spectrum of radial access complications is vital for optimizing patient care in interventional procedures.
Abstract:
The transradial approach for cardiac catheterization, coronary angiography, and percutaneous intervention is associated with a lower risk of access site-related complications compared to the transfemoral approach. However, with increasing utilization of transradial access for not only coronary procedures but also peripheral vascular procedures, healthcare personnel are more likely to encounter radial access site complications, which can be associated with morbidity and mortality. There is significant heterogeneity in the reporting of incidence, manifestations, and management of radial access site complications, at least partly due to vague presentation and under-diagnosis. Therefore, physicians performing procedures via transradial access should be aware of possible complications and remain vigilant to prevent their occurrence. Intraprocedural complications of transradial access procedures, which include spasm, catheter kinking, and arterial dissection or perforation, may lead to patient discomfort, increased procedure time, and a higher rate of access site cross over. Post-procedural complications such as radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve injury could lead to patient discomfort and limb dysfunction. When radial access site complications occur, comprehensive evaluation and prompt treatment is necessary to reduce long-term consequences. In this report, we review the incidence, clinical factors, and management strategies for radial access site complications associated with cardiac catheterization.
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