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Complications of Transradial
Approach
Olivier F. Bertrand, MD, PhDAssociate-Professor of Medicine, Laval UniversityAdjunct-Professor, Department of Mechanical Engineering, McGill University
Quebec Heart-Lung Institute
DUKE TRANSRADIAL ADVANCED COURSE20 OCTOBER 2011
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Disclosures
Research grants (IIT): Cordis, Eli-Lilly,
Bristol-Myers-Squibb,GE Healthcare,
Sanofi-Aventis, Eurocor
Consultant: Cordis, Astra-Zeneca,
OpsensResearch-Scholar from Quebec
Foundation for Health Research
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FUJII ET AL. J INV CARDIOL 2010;22:536-40
Upper Limb Vascularization
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Types of Vascular
Complications-CommonTypes Radial Femoral
Hematoma > 5cm
Pseudo-aneurysmA/V Fistula
Skin infection
Dissection/Rupture
ThrombosisDistant Bleeding
Nerve Injury
Atherosclerosis
< 1% 3-5%
< 1%
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Types of Vascular
Complications-SpecificTypes RadialCompartment syndrome
Spasm
Artery avulsion
Granulomatous skin reaction
Digital ischemia
Transient vocal cord paralysis
Mediastinal hematomaDelayed reflex sympathetic
dystrophy
Catheter entrapment
< 1
< 1%
< 1
case-report
case-report
case-report
case-report
case-report
case-report
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SpasmLack of definition...
No brachial artery spasm...look for recurrent artery..
Prevention >> Treatment
Risk factors: Smoking, small vessel, anxiety
Pharmaco: Calcium channel blockers or combo
Devices: Small sheath, hydrophylic, sheathless
If severe: sedation sympathetic block
COURTESY G BARBEAU
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Pseudo-aneurysm
True incidence probably underestimated
Importance of timing for diagnostic...
Risk factors: hypertension, chronic anticoagulation,types of closure devices ?
Rx: compression, echo-guided thrombin injection,
NO surgery
COLLINS ET AL. CCI 2011
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Dissection of Radial Artery
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Immediate Post-PCI
AngiogramSame-day transfer to
referring center
No Hematoma
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Bleeding at Distance from
Puncture Site
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Nursing Management
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TIZON H, BARBEAU G, J INTERV CARDIOL 2008
Prevention !!!!
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Radial Artery Occlusion
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Radial Artery Occlusion
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Radial Artery Occlusion
BERNAT I ET AL. AM J CARDIOL 2011 (IN PRESS)
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Retrograde Recanalization
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Retrograde Recanalization
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QHLI: Clinical Outcomes
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Post Retrograde Recanalization
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1 Week Post-Recanalization
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Catheter Entrapment...
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Radial vs Catheter Selection ?
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Conclusion
Complications of radial approach have been
well documented
Most are preventableOptimization still required for hemostasis and
prevention/treatment of RAO
Issue of coronary dissection ie single cathetermanipulation needs to be explored
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