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
- ↑ 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.