title: Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options.
abstract: OBJECTIVE
  We aimed to present our experience regarding the unusual vascular complications and specific treatment strategies in patients who underwent transradial coronary procedure (TRC).
  
  
  BACKGROUND
  Transradial access provides lower vascular access site complication rates compared with transfemoral access. However, there is lack of data obtained from large study populations concerning the incidence and treatment strategies of hemorrhagic and vascular complications following a TRC in the literature.
  
  
  METHODS
  10,324 patients (2,652 patients with percutaneous coronary intervention and 7,672 patients with a diagnostic transradial coronary angiography) who underwent a TRC from February 2010 to December 2014 were reviewed to identify cases of large hematoma, perforation, arteriovenous fistula, and pseudoaneurysm.
  
  
  RESULTS
  The observed incidence was 0.44% (45 patients) for all unusual vascular and hemorrhagic complications. Of these 45 patients; 32 patients (0.31%) presented with large hematoma (≥6 cm), 8 patients (0.08%) presented with perforation, 4 patients (0.04%) presented with arteriovenous fistula (AVF), and only 1 case (0.009%) presented with radial artery pseudoaneurysm. Forty-one of forty-five patients were managed with mechanical compression. Surgery was performed in only 3 cases; a patient with a brachial artery perforation leading to compartment syndrome, a patient with AVF resulting in limb ischemia, and a patient with radial artery pseudoaneurysm. A right internal mammarian artery perforation resulting in huge breast hematoma was treated via endovascular graft stent implantation.
  
  
  CONCLUSIONS
  Hemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction.
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Ersan
authors.initials: E
authors.lastname: Tatli
authors.affiliation: Department of Cardiology, Acibadem University School of Medicine, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Buturak
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Akif
authors.initials: A
authors.lastname: Cakar
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Bulent M
authors.initials: BM
authors.lastname: Vatan
authors.affiliation: Department of Cardiology, Acibadem University School of Medicine, Istanbul, Turkey.
authors.forename: Aleks
authors.initials: A
authors.lastname: Degirmencioglu
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Tarık M
authors.initials: TM
authors.lastname: Agac
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Harun
authors.initials: H
authors.lastname: Kilic
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Gunduz
authors.affiliation: Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Akdemir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology; D001164:Arteriovenous Fistula / Q000209:etiology; D001916:Brachial Artery / Q000293:injuries; D003161:Compartment Syndromes / Q000209:etiology; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008323:Mammary Arteries / Q000293:injuries; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods*; D017534:Radial Artery; D012189:Retrospective Studies