Radial catheterization pitfalls

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The data that had been published up till now entails an incidence of about 2% to 34% of radial artery spasm, which would result in transfemoral approach being used instead. [1] So some precautions should be made beforehand in anticipation of such complications.

  • ==Potential Pitfalls of the Radial Approach to Cardiac Catheterization==
  • 1- Spasm
  • 2- Vessel tortuosity. Some of the tortuous forms are:-
    • Alpha shape radial artery.
    • S-shaped radial artery.
    • Proximal and distal omega shaped radial artery.
    • Brachial alpha loop.
    • High origin radial artery.

3- Guide catheter support and selection may be reduced.

4- Loss of radial artery pulse in 4% of cases.

5- Potential increase in the duration of the procedure and fluroscopy time

6- The radial artery has been instrumented should there be a desire to use it as a conduit for CABG

7- It is the second and not the first approach learned by trainees

8- There is a learning curve in treating spasm, navigating anatomy, and manipulating catheters

9- Anatomically there can be a loop in the artery near the brachial in about 10% of cases

10- Smaller sheaths are required (4-8F)

References

  1. Hizoh I, Majoros Z, Major L, Gulyas Z, Szabo G, Kerecsen G; et al. (2014). "Need for prophylactic application of verapamil in transradial coronary procedures: a randomized trial. The VITRIOL (is Verapamil In TransRadial Interventions OmittabLe?) trial". J Am Heart Assoc. 3 (2): e000588. doi:10.1161/JAHA.113.000588. PMID 24732918.


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