Preventing and Managing Radial Artery Occlusion Following Transradial Procedures: Strategies and Considerations

Overview

Journal J Cardiovasc Dev Dis

Specialty Cardiology & Vascular Diseases

Date 2023 Jul 28

PMID 37504539

Authors

Grigorios Tsigkas

Amalia Papanikolaou

Anastasios Apostolos

Angelos Kramvis

Filippos Timpilis

Anastasia Latta

Michail I Papafaklis

Adel Aminian

Periklis Davlouros

Affiliations

Soon will be listed here.

Abstract

Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.

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References

Mizuguchi Y, Izumikawa T, Hashimoto S, Yamada T, Taniguchi N, Nakajima S . Efficacy and safety of the distal transradial approach in coronary angiography and percutaneous coronary intervention: a Japanese multicenter experience. Cardiovasc Interv Ther. 2019; 35(2):162-167. DOI: 10.1007/s12928-019-00590-0. View

Rao S, Wegermann Z . Pumping up best practices in radial artery access: prolonged occlusion flow-mediated dilation improves radial artery access success. EuroIntervention. 2021; 16(16):1299-1300. PMC: 9707427. DOI: 10.4244/EIJV16I16A233. View

Pancholy S . Comparison of the effect of intra-arterial versus intravenous heparin on radial artery occlusion after transradial catheterization. Am J Cardiol. 2009; 104(8):1083-5. DOI: 10.1016/j.amjcard.2009.05.057. View

Liang D, Lin Q, Zhu Q, Zhou X, Fang Y, Wang L . Short-Term Postoperative Use of Rivaroxaban to Prevent Radial Artery Occlusion After Transradial Coronary Procedure: The RESTORE Randomized Trial. Circ Cardiovasc Interv. 2022; 15(4):e011555. DOI: 10.1161/CIRCINTERVENTIONS.121.011555. View

Besli F, Gungoren F, Tanriverdi Z, Tascanov M, Fedai H, Akcali H . The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience. Acta Cardiol. 2019; 76(2):168-174. DOI: 10.1080/00015385.2019.1705584. View

Ezhumalai B, Satheesh S, Jayaraman B . Effects of subcutaneously infiltrated nitroglycerin on diameter, palpability, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography. Indian Heart J. 2015; 66(6):593-7. PMC: 4310967. DOI: 10.1016/j.ihj.2014.05.023. View

Sandoval Y, Bell M, Gulati R . Transradial Artery Access Complications. Circ Cardiovasc Interv. 2019; 12(11):e007386. DOI: 10.1161/CIRCINTERVENTIONS.119.007386. View

Uhlemann M, Mobius-Winkler S, Mende M, Eitel I, Fuernau G, Sandri M . The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications. JACC Cardiovasc Interv. 2012; 5(1):36-43. DOI: 10.1016/j.jcin.2011.08.011. View

Didagelos M, Pagiantza A, Zegkos T, Papanastasiou C, Zarra K, Angelopoulos V . Low-molecular-weight heparin in radial artery occlusion treatment: the LOW-RAO randomized study. Future Cardiol. 2021; 18(2):91-100. DOI: 10.2217/fca-2021-0067. View

10.

Dahm J, Vogelgesang D, Hummel A, Staudt A, Volzke H, Felix S . A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions. Catheter Cardiovasc Interv. 2002; 57(2):172-6. DOI: 10.1002/ccd.10321. View

11.

Petroglou D, Didagelos M, Chalikias G, Tziakas D, Tsigkas G, Hahalis G . Manual Versus Mechanical Compression of the Radial Artery After Transradial Coronary Angiography: The MEMORY Multicenter Randomized Trial. JACC Cardiovasc Interv. 2018; 11(11):1050-1058. DOI: 10.1016/j.jcin.2018.03.042. View

12.

Chen Y, Ke Z, Xiao J, Lin M, Huang X, Yan C . Subcutaneous Injection of Nitroglycerin at the Radial Artery Puncture Site Reduces the Risk of Early Radial Artery Occlusion After Transradial Coronary Catheterization: A Randomized, Placebo-Controlled Clinical Trial. Circ Cardiovasc Interv. 2018; 11(7):e006571. DOI: 10.1161/CIRCINTERVENTIONS.118.006571. View

13.

Fu Y, Zuo K, Yang Y, Gao Y, Liu L, Ding X . Distal Transradial Access: a Safe and Feasible Approach for Coronary Catheterization in Cases of Total Radial Artery Occlusion. J Cardiovasc Transl Res. 2022; 15(5):1203-1211. DOI: 10.1007/s12265-022-10238-9. View

14.

Pacchioni A, Ferro J, Pesarini G, Mantovani R, Mugnolo A, Bellamoli M . The Activated Clotting Time Paradox: Relationship Between Activated Clotting Time and Occlusion of the Radial Artery When Used as Vascular Access for Percutaneous Coronary Procedures. Circ Cardiovasc Interv. 2019; 12(9):e008045. DOI: 10.1161/CIRCINTERVENTIONS.119.008045. View

15.

Oliveira M, Navarro E, Caixeta A . Distal transradial access for coronary procedures: a prospective cohort of 3,683 all-comers patients from the DISTRACTION registry. Cardiovasc Diagn Ther. 2022; 12(2):208-219. PMC: 9011095. DOI: 10.21037/cdt-21-542. View

16.

Achim A, Kakonyi K, Jambrik Z, Olajos D, Nemes A, Bertrand O . Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience. J Clin Med. 2022; 11(23). PMC: 9740525. DOI: 10.3390/jcm11236916. View

17.

Sgueglia G, Di Giorgio A, Gaspardone A, Babunashvili A . Anatomic Basis and Physiological Rationale of Distal Radial Artery Access for Percutaneous Coronary and Endovascular Procedures. JACC Cardiovasc Interv. 2018; 11(20):2113-2119. DOI: 10.1016/j.jcin.2018.04.045. View

18.

Balaban Y, Elevli M . It is both possible and safe to perform coronary angiography through the same radial artery, after retrograde recanalization of radial artery occlusion, following a previous coronary angiography. J Interv Cardiol. 2018; 31(6):957-963. DOI: 10.1111/joic.12524. View

19.

Lin Y, Sun X, Chen R, Liu H, Pang X, Chen J . Feasibility and Safety of the Distal Transradial Artery for Coronary Diagnostic or Interventional Catheterization. J Interv Cardiol. 2020; 2020:4794838. PMC: 7744178. DOI: 10.1155/2020/4794838. View

20.

da Silva R, de Andrade P, Dangas G, Joaquim R, da Silva T, Vieira R . Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin: PATENS Trial. JACC Cardiovasc Interv. 2022; 15(10):1009-1018. DOI: 10.1016/j.jcin.2022.02.026. View