Abstract 19066: Routine Vascular Ultrasound After Radial Artery Catheterization Detects Clinically Silent Access Site Complications: Registry of 274 Consecutive Patients
Objectives: Radial access for coronary procedures is widely recommended to reduce vascular access site complications compared to femoral access. However, radial access still accounts for less than 10% of procedures worldwide and 1% of procedures in the USA.To assess the frequency of radial artery (RA) complications we performed routine ultrasound of the RA after each procedure in 274 consecutive pts. Material and
Methods: From 11/2009 until 05/2010, 274 consecutive pts. (64.6 ± 11 years (min. 33, max. 89 years), 61% male) were included in our prospective registry. A 6F standard short vascular sheath was used for radial access and 2500 IE unfractionated heparin were given routinely for a diagnostic angiography and 100 IE/kg bodyweight were given for percutaneous intervention. Vascular ultrasound of the access site was performed within 1±3 d after catheterization in all 274 pts. 40 pts. (14.6%) had a coronary intervention with full-dose heparinization, 20 pts. presented with an acute coronary syndrome.
Results: The access site was the right RA in 265 pts. (96.7%), in 9 pts. the left radial artery. Vascular access site complications were detected in 93 pts (34.1%), of whom 40 pts. were symptomatic (43%). Symptoms were pain in 37 pts and/or paraesthesia in 16 pts., no evidence of major bleeding. Occlusion of the RA occurred in 85 pts. (31.1 %), a pseudoaneurysm was seen in 3 patients and av-fistula in 2 pts. Two pseudoaneurysms could be managed successfully by ultrasound- guided compression, one patient required a vascular surgery. Mean occlusion length was 5.1±2.36 inch (min.1.8,max. 9.84 inch). In 39 pts. undergoing percutaneous coronary intervention there was evidence of RA occlusion in 10 pts. (25.6%)
Conclusions:The rate of RA occlusions detected by vascular ultrasound examination was higher than expected and reported in previous trials with clinical access site evaluation only. Clinical examination (inspection, palpation, auscultation) is insufficient and insensitive to detect all vascular access site complications. We therefore propose routine vascular ultrasound to monitor and reduce radial access site complications and to establish potential risk factors for complications (ineffective anticoagulation, use of sheaths without hydrophilic coating).
- © 2010 by American Heart Association, Inc.