Author + information
- S193687981631322X-8e02c9e45e7a9c7878b3c4cff92dd506James H. Beckmann, MD∗ ()
- ↵∗CardioVascular Institute of North Colorado, Banner Health, 1800 15th Street, Suite 310, Greeley, Colorado 80631
Mina et al. (1) and their engendered comments (2), when assessing the benefits of radial artery access, have focused on radial artery bleeding when comparing access site to that of a femoral artery approach. More importantly than radial artery bleeding itself would be radial artery occlusion and thus the ability to potentially use the same site for further access if needed. Numerous studies have undeniably shown less bleeding with radial access over femoral access, but the true incidence of radial artery occlusion, much less the factors that are of most import in its occurrence and prevention, is not determined (3,4). Radial occlusion has been described anywhere from 5% to 9.5% after its use for diagnostic and interventional catheterization (3,4), partially dependent on when the assessment of patency has been made (early vs. late). The method of compression and the timing protocol in easing compression on the radial artery will no doubt effect patency rates (5).
Aggressive attempts to achieve patency of the radial artery following sheath removal should be made in the cath lab prior to the patient’s departure from the suite. Compression time, when patency is not present at time of departure from the cath lab, should be kept to a minimal of 1.5 to 2 h maximal. Once patency is achieved, the time that a compression band is left in place should matter little.
In studies comparing radial versus femoral complications, occlusion of the artery at the access site should now be deemed important to report. This could even make the math “fuzzier.” Then, efforts should be made to identify preventive factors and promote standards in clinical practice to reduce the incidence of this particular complication.
Please note: Dr. Beckman has reported that he has no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Mina G.S.,
- Gobrial G.F.,
- Modi K.,
- Dominic P.
- Rao S.V.,
- Shah R.
- Kotowycx M.A.,
- Dzavik V.