Transradial artery coronary angiography and intervention in patients with severe peripheral vascular disease

doi:10.1016/S0009-9260(97)80103-1

Clinical Radiology

Volume 52, Issue 2, February 1997, Pages 115-118

https://doi.org/10.1016/S0009-9260(97)80103-1 Get rights and content

Abstract

Background:

Traditionally, cardiac catheterization in patients with severe aorto-iliac disease has been performed using a brachial arteriotomy. This approach is associated with significant vascular and neuronal complications and requires considerable training to achieve an adequate level of expertise. Improvement and miniaturization of catheter equipment now allows the radial artery to be used for coronary investigation and intervention. The lack of important structures close to the radial artery, a good collateral ulnar artery circulation and its superficial position suggests that these procedures should have a low complication rate. The purpose of this study was to assess the efficacy and safety of percutaneous transradial diagnostic and interventional coronary catheterization in patients with severe peripheral vascular disease.

Patients and methods:

We undertook a non-randomized prospective analysis of 75 patients who had transradial artery diagnostic and interventional coronary catheterization in whom femoral angiography was impossible or relatively contraindicated (22 patients with severe claudication and absent femoral pulses, 24 patients with previous aorto-iliac surgery or intervention, 20 patients with a failed femoral approach, 9 patients with an aortic aneurysm). Three patients had an absent ulnar artery and were excluded.

Results:

Radial artery cannulation was successful in 73/75 (97%) cases. Seventy-one (95%) patients had a successful diagnostic study. There was a high incidence of 3 vessel disease (73%), and the majority of patients (64%) were referred for coronary bypass surgery. Twelve patients underwent successful follow-on intervention including the insertion of 9 intracoronary stents. Adequate haemostasis was achieved within 20 min after diagnostic angiography and 60 min after interventional procedures. One patient had a forearm haematoma with paraesthesia of the hand which settled with conservative treatment. At 4–6 weeks, all patients had normal hand sensation and function (100%) with a palpable pulse present in 59/62 (96%). All patients undergoing diagnostic angiography were discharged on the same day, and patients undergoing intervention were discharged the following day.

Conclusions:

Transradial coronary investigation and intervention can be performed with a high degree of success and a low complication rate with early mobilization and discharge in patients with severe peripheral vascular disease. We suggest that the percutaneous transradial technique should be considered as an alternative to the Sones' technique in these patients.

References (13)

KiemeneijF et al.
Transradial artery coronary angioplasty
American Heart Journal
(1995)
RyanTJ et al.
Guidelines for percutaneous transluminal coronary angioplasty: a report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty)
Journal of the American College of Cardiologists
(1988)
JudkinsMP et al.
Prevention of complications of coronary arteriography
Circulation
(1974)
SonesFH et al.
Cine coronary arteriography
Modern Concepts in Cardiovascular Disease
(1962)
GrossmanW
Complications of cardiac catheterization: incidence, causes and prevention
CampeauL
Percutaneous radial artery approach for coronary angiography
Catheterization and Cardiovascular Diagnosis
(1989)

There are more references available in the full text version of this article.

Cited by (20)

Transradial peripheral arterial procedures
2015, Interventional Cardiology Clinics
Citation Excerpt :
A recent update using a retrospective cohort study from the CATH-PCI data registry showed an increase in TR interventions in the United States from 1.2% in the first quarter of 2007 to 16.1% in the third quarter of 2012, and may well be more than 20% at this time.4 In the presence of peripheral vascular disease (PVD), diagnostic and interventional cardiac catheterization procedures are associated with higher incidences of access-related complications.5–7 A substudy of the CARP trial looked at 1298 patients with PVD undergoing diagnostic cardiac catheterization and showed a greater frequency of complications, including 22 major and 27 minor access-related complications.8
Symptomatic radial artery thrombosis successfully treated with endovascular approach via femoral access route
2014, Cardiovascular Revascularization Medicine
Citation Excerpt :
Transradial access (TRA) for cardiac catheterization is safe with lower risk of vascular complications in comparison to transfemoral access [3]. Other benefits of TRA include short hospital stay, increasing cost effectiveness, and early mobility after the procedure with higher success rates in patients with peripheral vascular disease [4]. In one study, TRA was also associated with lower mortality in high risk patients such as those with ST segment elevation myocardial infarction (STEMI) [5].
Radial access has been increasingly utilized for coronary intervention due to higher safety profile in comparison to femoral access site with lower bleeding rate. Radial artery occlusion is not uncommon with radial access site. This usually does not lead to any harm due to ulnar artery collaterals that are sufficient to prevent hand ischemia and is usually left alone. However, in the case of significant hand ischemia, treatment is often necessary. We are reporting an interesting case of symptomatic radial artery thrombosis leading to arm ischemia that was successfully treated percutaneously using femoral access. Using femoral access for radial artery intervention has not been reported previously. This case is followed by review of the literature.
Coronary angiography from the radial artery - Experience, complications and limitations
1998, International Journal of Cardiology
Aims: to assess the outcomes, complications and limitations of coronary angiography performed via percutaneous radial artery puncture. Methods and results: two hundred and fifty patients underwent diagnostic coronary angiography from the radial artery, 182 (72.8%) of whom had contraindications to the femoral approach, for example due to peripheral vascular disease (n=85), therapeutic anticoagulation (29), or failed femoral approach (17). Procedural success in this high-risk population was achieved in 231 patients (92.4%). Principle reasons for failure were unsuccessful radial access (5) and arterial spasm (5). Procedure duration (SD) for an operator's first 20 cases compared with cases thereafter (min) was 47.7 (16.7) vs. 41.5 (14.6), P=0.0004; fluoroscopy time (min) 9.7 (7.1) vs. 6.6 (5.1), P=0.0001 and procedural success 89.6% vs. 94.1%, P=ns. Complications included two deaths associated temporally with catheterisation, three cases of arterial dissection without ischaemic sequelae and one transient ischaemic attack. Conclusions: coronary angiography can be performed successfully from the radial artery, but this approach has limitations, which include the need to demonstrate dual palmar vascular supply, the prolonged learning phase, the procedural failure rate, patient discomfort and a demonstrable incidence of vascular and haemodynamic complications. We believe that radial coronary angiography should only be undertaken when there is a contraindication to the femoral approach.
Comparison of radial versus brachial approaches for diagnostic coronary angiography when the femoral approach is contraindicated
1998, American Journal of Cardiology
Retrograde Tibio-Pedal Access for Revascularization of Lower-Extremity Peripheral Artery Disease Using a 6 Fr Slender Sheath: The "pedal-First" Pilot Project
2018, Journal of Invasive Cardiology
Incidence and clinical course of limb dysfunction post cardiac catheterization: A systematic review
2018, Circulation Journal

View all citing articles on Scopus

View full text

Original PaperTransradial artery coronary angiography and intervention in patients with severe peripheral vascular disease

Abstract

Background:

Patients and methods:

Results:

Conclusions:

American Heart Journal

Journal of the American College of Cardiologists

Prevention of complications of coronary arteriography

Circulation

Cine coronary arteriography

Modern Concepts in Cardiovascular Disease

Complications of cardiac catheterization: incidence, causes and prevention

Percutaneous radial artery approach for coronary angiography

Catheterization and Cardiovascular Diagnosis

Original Paper
Transradial artery coronary angiography and intervention in patients with severe peripheral vascular disease