Upper-extremity dysfunction following transradial percutaneous procedures: an overlooked and disregarded complication?

of the hand. However, these described complications may ultimately result in upper extremity dysfunction in patients. Zwaan and colleagues performed an extensive systematic review and meta-analysis on all access site complications and subsequent upper extremity dysfunction following TR-PCI and cardiac catheterisation [9]. Upper extremity dysfunction was defined as loss of strength, sensory loss, coordination and/or loss of active range of motion, ascertained by patient history and/or through physical examination. Other reported complications of TR-PCI included upper extremity ischaemia, pain, radial artery spasm, radial artery occlusion, access site bleeding, access site haematoma, perforation, dissection, swelling, compartment syndrome, pseudoaneurysm, arteriovenous fistula, and infection/inflammation. A total of 176 studies were found eligible, including 14 articles on the incidence of upper extremity dysfunction. The authors report a pooled incidence of upper extremity dysfunction following TR-PCI and cardiac catheterisation of 0.32 % (0.10–1.01). There are some discrepancies among the included studies on how upper extremity dysfunction was assessed, which varies from investigating the handgrip strength to evaluating functional loss by history of followup. In particular in the former situation, this could result in underestimation of upper extremity dysfunction. Thus, it is questionable and a limitation of the study to lump these studies together. However, restricting the included studies to a more uniform assessment of upper extremity dysfunction would severely limit the eligible studies. Other frequently reported complications following TR-PCI and catheterisations included pain with a mean pooled incidence of 7.65 % (4.51–12.67), early radial artery occlusion with a pooled incidence of 3.45 (2.59–4.58) and late radial artery occlusion with a pooled incidence of 3.34 % (2.57–4.32). Recently Van Leeuwen et al. prospectively investigated upper limb function in 338 patients undergoing coronary Following the introduction of transradial percutaneous coronary intervention (TR-PCI), a superficial and readily compressible access site, there have been several randomised controlled trials where TR-PCI was compared with transfemoral PCI. Currently, the radial artery is the preferred access route for catheterisation and PCI, mainly due to the lower number of access site related complications [1]. In particular in ST-segment elevation myocardial infarction patients, TR-PCI was associated with lower rates of mortality, and major and access site bleeding compared with the transfemoral approach [2−5]. Bleeding is among the most common in-hospital complications of PCI and is independently associated with increased mortality [6, 7]. Moreover, TR-PCI allows fast mobilisation of the patient and aids in reducing the in-hospital stay of STEMI patients [8]. Despite these clinical advantages, TR-PCI is technically more challenging due to the complex anatomical variability of nerves and blood vessels in the upper extremity. The radial artery is more susceptible to vasospasm, in particular in elderly, female and diabetic patients. This is often ascribed to the smaller calibre of the artery. Complications following TR-PCI include radial artery spasm, radial artery occlusion, access site bleeding, perforation, dissection, compartment syndrome, pseudo-aneurysm, arteriovenous fistula, infection and inflammation, swelling and pain. Of these complications, radial artery occlusion is the most common with a pooled incidence rate of up to 5 %. This is often asymptomatic or subclinical due to the collateral circulation