title: Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization.
abstract: Radial artery occlusion (RAO) can result from transradial catheterization. We compared the incidence of RAO with 2 heparin dosage regimens after transradial coronary angiography, and we evaluated the efficacy and safety of transient homolateral ulnar artery compression to achieve acute radial artery recanalization. Patients referred for coronary angiography were randomized to very-low-dose heparin (2,000 IU) or low-dose heparin (5,000 IU). On sheath removal, hemostasis was obtained using the TR band with a plethysmography-guided patent hemostasis technique. In the case of RAO as assessed by duplex ultrasonography 3 to 4 hours after hemostasis, immediate 1-hour ulnar artery compression was applied. Hematomas >15 cm(2) were also assessed. We randomized 465 patients, 222 in the 2,000-IU group and 243 in the 5,000-IU group. The baseline and procedural characteristics were comparable in both groups. The incidence of initial RAO was 5.9% in the 2,000-IU group and 2.9% in the 5,000-IU group (p = 0.17), with a compression time of 2.10 ± 0.78 hours and 2.25 ± 0.82 hours, respectively (p = 0.051). After ulnar artery compression, the final incidence of RAO was 4.1% in the 2,000-IU group and 0.8% in the 5,000-IU group (p = 0.03). The incidence of local hematoma was 2.3% and 3.7% in the 2,000- and 5,000-IU groups, respectively (p = 0.42). In conclusion, acute RAO after transradial catheterization can be recanalized by early 1-hour homolateral ulnar artery compression. This simple nonpharmacologic method was effective and safe in patients with very-low- and low-dose heparin. Nevertheless, the incidence of final RAO remained significantly lower after a higher anticoagulation level.
authors: University Hospital and Faculty of Medicine, Pilsen, Czech Republic. ivobernat@gmail.com
authors: Ivo
authors: I
authors: Bernat
authors: Olivier F
authors: OF
authors: Bertrand
authors: Richard
authors: R
authors: Rokyta
authors: Martin
authors: M
authors: Kacer
authors: Jan
authors: J
authors: Pesek
authors: Jiri
authors: J
authors: Koza
authors: Michal
authors: M
authors: Smid
authors: Hana
authors: H
authors: Bruhova
authors: Gabriela
authors: G
authors: Sterbakova
authors: Lucie
authors: L
authors: Stepankova
authors: Olivier
authors: O
authors: Costerousse
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D016896:Treatment Outcome; D017535:Ulnar Artery
chemical_list: D000925:Anticoagulants; D006493:Heparin