Radial catheterization complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Complications

Radial Artery Spasm

Radial artery spasm (RAS) remains one of the major limitations of transradial approach for PCI.[1] The radial artery was demonstrated to have stronger contractions to common vasoactive substances, thus, increasing its propensity to spasm especially in situations of trauma[2] The incidence of RAS varies from 12% among high risk patients in whom transfemoral approach was contraindicated[3] to 22% among patients without prior administration of intra-arterial vasodilators.[4] The increased incidence in RAS may be due to the small size of radial artery, female gender, long and difficult procedures with multiple catheter exchanges, sheath size, and operator inexperience.[5]

Some of the measures that have been shown to reduce the incidence and severity of RAS include:

  • Generous patient sedation
  • Use of spasmolytic cocktails such as verapamil, nitroprusside or combination of both[6][7][8]
  • Use of a hydrophilic sheath of the smallest possible diameter
  • Wiping and flushing catheters with solutions containing calcium channel blocker or nitrates
  • Using a smaller catheter size
  • Use of intra-arterial Papaverine for the treatment of severe arterial spasm[9]

Radial Artery Occlusion

  1. Hematoma leading to compartment syndrome[10]
  2. Local pain and swelling
  3. Thrombosis
  4. Embolization[11]
  1. Infection[12]
  2. Pseudoaneurysm[13]
  3. Blood loss[14]
  1. Limb ischemia
  2. Arteriovenous fistula
  3. Cerebral embolization[15]
  4. Peripheral neuropathy

Optical coherence tomography (OCT) has been used by Yonetsu et al to define the damage to the radial artery in 73 arteries of 69 patients [16]. 32% of patients developed intimal tears and 16% of patients developed medial dissections. Repeat catheterization was associated with increased fibro-intimal hyperplasia. Cardiac catheterization via the radial approach may render the radial artery unsuitable for coronary artery bypass grafting. There can be a loss of pulse in about 4% of cases. Use of smaller guide catheters and sheathless guides may potentially reduce the risk of these complications.

References

  1. ↑ Varenne, O.; Jégou, A.; Cohen, R.; Empana, JP.; Salengro, E.; Ohanessian, A.; Gaultier, C.; Allouch, P.; Walspurger, S. (2006). "Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study". Catheter Cardiovasc Interv. 68 (2): 231–5. doi:10.1002/ccd.20812. PMID 16819768. Unknown parameter |month= ignored (help)
  2. ↑ Chardigny, C.; Jebara, VA.; Acar, C.; Descombes, JJ.; Verbeuren, TJ.; Carpentier, A.; Fabiani, JN. (1993). "Vasoreactivity of the radial artery. Comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery". Circulation. 88 (5 Pt 2): II115–27. PMID 8222146. Unknown parameter |month= ignored (help)
  3. ↑ Hildick-Smith, DJ.; Walsh, JT.; Lowe, MD.; Shapiro, LM.; Petch, MC. (2004). "Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases". Catheter Cardiovasc Interv. 61 (1): 60–6. doi:10.1002/ccd.10708. PMID 14696161. Unknown parameter |month= ignored (help)
  4. ↑ Kiemeneij, F.; Vajifdar, BU.; Eccleshall, SC.; Laarman, G.; Slagboom, T.; van der Wieken, R. (2003). "Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures". Catheter Cardiovasc Interv. 58 (3): 281–4. doi:10.1002/ccd.10445. PMID 12594687. Unknown parameter |month= ignored (help)
  5. ↑ Varenne, O.; Jégou, A.; Cohen, R.; Empana, JP.; Salengro, E.; Ohanessian, A.; Gaultier, C.; Allouch, P.; Walspurger, S. (2006). "Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study". Catheter Cardiovasc Interv. 68 (2): 231–5. doi:10.1002/ccd.20812. PMID 16819768. Unknown parameter |month= ignored (help)
  6. ↑ Attaran, S.; John, L.; El-Gamel, A. (2008). "Clinical and potential use of pharmacological agents to reduce radial artery spasm in coronary artery surgery". Ann Thorac Surg. 85 (4): 1483–9. doi:10.1016/j.athoracsur.2007.10.042. PMID 18355566. Unknown parameter |month= ignored (help)
  7. ↑ Kiemeneij, F.; Vajifdar, BU.; Eccleshall, SC.; Laarman, G.; Slagboom, T.; van der Wieken, R. (2003). "Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures". Catheter Cardiovasc Interv. 58 (3): 281–4. doi:10.1002/ccd.10445. PMID 12594687. Unknown parameter |month= ignored (help)
  8. ↑ Varenne, O.; Jégou, A.; Cohen, R.; Empana, JP.; Salengro, E.; Ohanessian, A.; Gaultier, C.; Allouch, P.; Walspurger, S. (2006). "Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study". Catheter Cardiovasc Interv. 68 (2): 231–5. doi:10.1002/ccd.20812. PMID 16819768. Unknown parameter |month= ignored (help)
  9. ↑ Osman, F.; Buller, N.; Steeds, R. (2008). "Use of intra-arterial papaverine for severe arterial spasm during radial cardiac catheterization". J Invasive Cardiol. 20 (10): 551–2. PMID 18830002. Unknown parameter |month= ignored (help)
  10. ↑ Araki T, Itaya H, Yamamoto M (2010). "Acute compartment syndrome of the forearm that occurred after transradial intervention and was not caused by bleeding or hematoma formation". Catheter Cardiovasc Interv. 75 (3): 362–5. doi:10.1002/ccd.22282. PMID 19821498.
  11. ↑ Downs JB, Rackstein AD, Klein EF, Hawkins IF (1973). "Hazards of radial-artery catheterization". Anesthesiology. 38 (3): 283–6. PMID 4698148.
  12. ↑ Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K; et al. (1996). "Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients". Crit Care Med. 24 (11): 1818–23. PMID 8917031.
  13. ↑ Inan MB, Acikgoz B, Yazicioglu L, Kaya B, Ozyurda U (2011). "A rare complication of radial artery catheterization". Vascular. 19 (3): 167–9. doi:10.1258/vasc.2010.cr0238. PMID 21652670.
  14. ↑ Smoller BR, Kruskall MS (1986). "Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements". N Engl J Med. 314 (19): 1233–5. doi:10.1056/NEJM198605083141906. PMID 3702919.
  15. ↑ Lund C, Nes RB, Ugelstad TP, Due-Tønnessen P, Andersen R, Hol PK; et al. (2005). "Cerebral emboli during left heart catheterization may cause acute brain injury". Eur Heart J. 26 (13): 1269–75. doi:10.1093/eurheartj/ehi148. PMID 15716287.
  16. ↑ Yonetsu T, Kakuta T, Lee T, et al. Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomography. Eur Heart J. 2010;Epub ahead of print.

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