Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures.
BACKGROUND
Access-site vascular complications (ASVC) in patients undergoing trans-radial coronary procedures are rare but may have relevant clinical consequences. Data regarding the optimal management of radial-access-related ASVC are lacking.


METHODS
During a period of 6 years we prospectively collected ASVC. ASVC were defined as any complication requiring ultrasound examination or upper limb angiography. ASVC were categorized according to the timing of diagnosis: "very early" (in the cath lab), "early" (after cath lab discharge, but during the hospital stay) and "late" (after hospital discharge). The need of surgery (primary end-point) and the development of neurological hand deficit (secondary end-point) were assessed.


RESULTS
Fifty-seven radial-artery related ASVC were collected. ASVC diagnosis was obtained by upper limb angiography in 25 patients (44%) and by Doppler in 32 patients (56%). Surgery was required in 6 cases (11%), the remaining patients receiving successful conservative management (which included prolonged local compression). Three patients (who received surgery) exhibited a mild neurological hand deficit in the follow-up. Need for surgery differed significantly according to timing of diagnosis as it occurred in 1 of 26 patients (3.8%) with "very early" diagnosis, in 1 of 21 patients (4.8%) with "early" diagnosis, and in 4 of 10 patients (40%) with "late" diagnosis (p=0.026).


CONCLUSIONS
ASVC are diagnosed with different timing after trans-radial procedures. Conservative management including local compression allows successful management in the majority of ASVC. Prompt recognition is pivotal as late diagnosis is associated to the need for surgery.
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. f.burzotta@rm.unicatt.it
Francesco
F
Burzotta
Luca
L
Mariani
Carlo
C
Trani
Valentina
V
Coluccia
Marta Francesca
MF
Brancati
Italo
I
Porto
Antonio Maria
AM
Leone
Giampaolo
G
Niccoli
Antonella
A
Tommasino
Giovanni
G
Tinelli
Mario Attilio
MA
Mazzari
Rocco
R
Mongiardo
Francesco
F
Snider
Giovanni
G
Schiavoni
Filippo
F
Crea
D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D019468:Disease Management; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy*; D011446:Prospective Studies; D017534:Radial Artery / Q000473:pathology*; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome