High Radial Artery Puncture Reduces CRPS Risk for Women: A Retrospective Case Series

Background/Objectives: Radial artery access (RAA) is widely used for catheter-based procedures due to its safety and convenience, but complex regional pain syndrome (CRPS) remains a rare, underrecognized complication-particularly in women. CRPS manifests as prolonged, severe pain and autonomic symptoms, often associated with nerve irritation near the carpal tunnel. This study aimed to evaluate whether modifying the puncture site to a high radial artery puncture (HRAP) reduces the risk of CRPS in patients undergoing transarterial micro-embolization (TAME) for frozen shoulder. Methods: We retrospectively reviewed 97 patients (47 women and 50 men) who underwent transarterial micro-embolization (TAME) via conventional RAA for frozen shoulder between February and June 2019. The occurrence of CRPS and vascular complications was recorded. All punctures were ultrasound-guided. Results: Among women treated via conventional RAA, five developed CRPS and one had radial artery occlusion. CRPS symptoms included intense puncture site pain (mean duration was 47 days), which severely impaired daily function. No complications occurred in men. Following the adoption of HRAP, no cases of CRPS, prolonged pain, or vascular complications were observed in the consecutive 101 women treated. Conclusions: Our findings suggest HRAP reduces CRPS risk by avoiding superficial nerve branches and targeting deeper arterial segments with fewer sensory structures. This ultrasound-guided modification is simple, does not require additional training, and may be widely applicable in both musculoskeletal and cardiovascular interventions. HRAP may help minimize neuropathic complications in broader patient populations.