Advances in Interventional Cardiology Radial Artery Patency After Transradial Catheterization

The transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications1–3 and has been shown to reduce major bleeding when compared with the femoral approach.4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization.3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients4 – 6 and is associated with decreased cost.5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1–10% of cases,9–14 it has been described as the “Achilles’ heel” of the transradial technique.15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge.16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported.17–19 Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient’s hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication.