title: Impact of Catheter Sheath Insertion into the Radial Artery on Vascular Endothelial Function Assessed by Reactive Hyperemia Peripheral Arterial Tonometry.
abstract: The transradial approach has been used for coronary procedures, but this procedure carries a risk of injury to the endothelium of the radial artery. In this study, the vascular dysfunction caused by transradial catheterization was examined using reactive hyperemia peripheral arterial tonometry (RH-PAT), a recently developed technique for assessing endothelial function in digits, and the differences in injuries were compared according to the size of sheath.Forty-three patients undergoing transradial catheterization with 6-Fr sheaths (n = 17) or 4-Fr/5-Fr (non-6-Fr; n = 26) sheaths underwent RH-PAT using an Endo-PAT2000 before, the day after, and 6 months after catheterization. RH-PAT was assessed in the arm of sheath placement and in the other arm as a control.RH-PAT values decreased from 2.42 ± 0.67 before catheterization to 2.08 ± 0.41 the day after catheterization in the 6-Fr group (P = 0.031); this was more evident in patients with a longer procedure time (> 91 minutes). In contrast, the change in the non-6-Fr group was not significant. RH-PAT of the non-catheterized arm was unchanged in both groups. At 6 months after catheterization, RH-PAT values in the 6-Fr group had not completely returned to baseline.In conclusion, the insertion of a 6-Fr catheter sheath into the radial artery, especially with a longer procedure time, impaired vascular endothelial function assessed by RH-PAT the day after the procedure and was sustained for 6 months. Thus, the use of smaller size sheaths (< 6-Fr) with a shorter procedure should be considered when performing transradial catheterization.
authors.affiliation: Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Nakata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikeda
authors.forename: Seiji
authors.initials: S
authors.lastname: Koga
authors.forename: Takeo
authors.initials: T
authors.lastname: Yoshida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koide
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawano
authors.forename: Koji
authors.initials: K
authors.lastname: Maemura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D062906:Cardiac Catheters / Q000009:adverse effects / Q000592:standards; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D004730:Endothelium, Vascular / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D004867:Equipment Design; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis*; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D017534:Radial Artery / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D015203:Reproducibility of Results; D013997:Time Factors; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control