Hand complications following radial artery catheterization for cardiac angiography
Jamison Harvey, BSc; Sarasa Tiffany Kim, BSc; Mollie E Ireson, BSc; Rajiv Gulati, MD, PhD; Malcolm R Bell, MD; Steven L. Moran, MD
Mayo Clinic School of Medicine, Rochester, MN
The radial artery is increasingly becoming the vessel of choice for cannulation in coronary angiography and percutaneous coronary intervention (PCI); however radial artery cannulation imposes risks to the hand and upper extremity. The goals of this study were to determine the frequency and types of upper limb complications, including need for surgical intervention, following radial artery access.
Materials & Methods
After IRB approval, a retrospective review was conducted of electronic medical records of patients that underwent coronary angiography +/- PCI with radial artery access between 2009 and September 2016. The Kaplan Meier method was used to estimate survival to a first complication and/or death. The Cox model was used to assess risk factors for complication and death.
A total of 10,540 patients were included in the analysis (68.5% male) and a median age of 66.7 [IQR 57.8, 74.9]. There were a total of 79 complications diagnosed within 60 days 0.84% (95% CI, 0.65%-1.02%). The most common complication was hematoma (n=39), followed by radial artery occlusion (n=28). Other complications included pseudoaneurysm (n=7), arteriovenous fistula (n=3), carpal tunnel syndrome (n=4), arterial perforation (n=3), vasopasm (n=2), compartment syndrome (n=1), and tendoninitis (n=1). The complications were diagnosed on a median of 1 day (IQR 0, 7) after the procedure and were assessed up to 60 days. Women were at increased risk for a hand complication (p <.0001; HR 2.4; 95% CI, 1.5-3.7). Diabetes, age, BMI, and catheter size were not associated with increased risk of hand complication (p>0.05). Ten patients required operative management of their hand complication. Operative management was indicated in symptomatic cases of radial artery occlusions, pseudoaneurysms, AV fistulas, and compartment syndrome. There were no identifiable risk factors for the need for surgical intervention.
In this series, the rate of hand complications following radial artery access for coronary angiography and PCI is very small; however, patients should be monitored for complications such as occlusion, bleeding, compartment syndrome, AV fistula, and pseudoaneursym. The majority of complications presented within one week.
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