title: Transradial cardiac catheterization: a review of access site complications.
abstract: Transradial catheterization (TRC) has been associated with a lower incidence of major access site related complications as compared to the transfemoral approach. With the increased adoption of transradial access, it is essential to understand the potential major and minor complications of TRC. The most common complication is asymptomatic radial artery occlusion, which rarely leads to clinical events, owing to the dual collateral perfusion of the hand. Adequate anticoagulation, appropriate compression techniques, and smaller sheath size can minimize the risk of radial artery occlusion. Hand ischemia with necrosis has never been reported during TRC with thorough pre-examination of intact collateral circulation. Radial artery spasm is relatively common, and can result in access and procedural failure. It can be prevented by the use of vasodilator cocktails and hydrophilic sheaths. Radial artery perforation can lead to severe forearm hematoma and compartment syndrome if not managed promptly. Careful observation, prompt detection of the hematoma, and management with a pressure bandage dressing are critical to avoid serious complications. Pseudoaneurym and arteriovenous fistula are rare complications, which can likely be managed conservatively without surgical intervention. Nerve injury occurring during access has been reported. Close observation for improvement is necessary, although symptoms usually improve over time. In summary, to prevent access site complications, avoidance of multiple punctures, gentle catheter manipulation, use of guided compression, coupled with careful observation for adverse warning signs such as hematoma, loss of pulse, pain, are critical for safe and effective TRC.
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA. yumikanei@hotmail.com
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
authors.forename: Tak
authors.initials: T
authors.lastname: Kwan
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nakra
authors.forename: Michael
authors.initials: M
authors.lastname: Liou
authors.forename: Yili
authors.initials: Y
authors.lastname: Huang
authors.forename: Lori L
authors.initials: LL
authors.lastname: Vales
authors.forename: John T
authors.initials: JT
authors.lastname: Fox
authors.forename: Jack P
authors.initials: JP
authors.lastname: Chen
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D017534:Radial Artery; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome