Author + information
- Received August 17, 2011
- Accepted August 31, 2011
- Published online January 1, 2012.
- Madlen Uhlemann, MD,
- Sven Möbius-Winkler, MD,
- Meinhard Mende, PhD,
- Ingo Eitel, MD,
- Georg Fuernau, MD,
- Marcus Sandri, MD,
- Volker Adams, PhD,
- Holger Thiele, MD,
- Axel Linke, MD,
- Gerhard Schuler, MD and
- Stephan Gielen, MD⁎ ( )()
- ↵⁎Reprint requests and correspondence:
Dr. Stephan Gielen, Department of Internal Medicine/Cardiology, University of Leipzig, Heart Centre, Strümpellstrasse 39, 04289 Leipzig, Germany
Objectives This study investigated the impact of sheath size on the rate of radial artery occlusions (RAO) (primary objective) and other access site complications (hemorrhage, pseudoaneurysm, arteriovenous fistula) as secondary objectives after transradial coronary catheterization.
Background The number of vascular access complications in the published data ranges from 5% to 38% after transradial catheterization.
Methods Between November 2009 and August 2010, 455 patients 65.3 ± 10.9 years of age (62.2% male) with transradial access with 5-F (n = 153) or 6-F (n = 302) arterial sheaths were prospectively recruited. Duplex sonography was obtained in each patient before discharge. Patients with symptomatic RAO were treated with low-molecular-weight heparin (LMWH), and a follow-up was performed.
Results The incidence of access site complications was 14.4% with 5-F sheaths compared with 33.1% with 6-F sheaths (p < 0.001). Radial artery occlusion occurred in 13.7% with 5-F sheaths compared with 30.5% with 6-F sheaths (p < 0.001). There was no difference between groups with regard to hemorrhage, pseudoaneurysms, or arteriovenous fistulas. Female sex, larger sheath size, peripheral arterial occlusive disease, and younger age independently predicted RAO in multivariate analysis. In total, 42.5% of patients with RAO were immediately symptomatic; another 7% became symptomatic within a mean of 4 days. Of patients with RAO, 59% were treated with LMWH. The recanalization rates were significantly higher in patients receiving LMWH compared with conventional therapy (55.6% vs. 13.5%, p < 0.001) after a mean of 14 days.
Conclusions The incidence of RAO by vascular ultrasound was higher than expected from previous data, especially in patients who underwent the procedure with larger sheaths.
- access site complications
- radial artery occlusion
- transradial coronary angiography and intervention
- vascular ultrasound
Dr. Möbius-Winkler is a proctor for Atritech Inc. Dr. Linke received honoraria and is a consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 17, 2011.
- Accepted August 31, 2011.
- American College of Cardiology Foundation