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Upper Extremity Function following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trial. J Interv Cardiol 2022; 2022:6858962. [PMID: 36128073 PMCID: PMC9470353 DOI: 10.1155/2022/6858962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives. To determine the incidence of upper extremity dysfunction (UED), after a transradial percutaneous coronary intervention (TR-PCI). Background. Transradial approach (TRA) is the preferred approach for coronary interventions. However, upper extremity complications may be underreported. Methods. The ARCUS was designed as a prospective cohort study, including 502 consecutive patients admitted for PCI. Patients treated with transfemoral PCI (TF-PCI) acted as a control group. A composite score of physical examinations and questionnaires was used for determining UED. Clinical outcomes were monitored during six months of follow-up, with its primary endpoint at two weeks. Results. A total of 440 TR-PCI and 62 control patients were included. Complete case analysis (n = 330) at 2 weeks of follow-up showed that UED in the TR-PCI group was significantly higher than that in the TF-PCI group: 32.7% versus 13.9%, respectively (
). The three impaired variables most contributing to UED were impaired elbow extension, wrist flexion, and extension. Multivariate logistic regression showed that smokers were almost three times more likely to develop UED. Conclusions. This study demonstrates that UED seems to occur two times more in TR-PCI than in TF-PCI at 2 weeks of follow-up. However, no significant long-term difference or difference between the intervention arm and the contralateral arm was found at all timepoints.
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Radial Artery Access Complications: Prevention, Diagnosis and Management. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40:163-171. [PMID: 34952824 DOI: 10.1016/j.carrev.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 01/04/2023]
Abstract
The transradial approach for cardiac catheterization, coronary angiography, and percutaneous intervention is associated with a lower risk of access site-related complications compared to the transfemoral approach. However, with increasing utilization of transradial access for not only coronary procedures but also peripheral vascular procedures, healthcare personnel are more likely to encounter radial access site complications, which can be associated with morbidity and mortality. There is significant heterogeneity in the reporting of incidence, manifestations, and management of radial access site complications, at least partly due to vague presentation and under-diagnosis. Therefore, physicians performing procedures via transradial access should be aware of possible complications and remain vigilant to prevent their occurrence. Intraprocedural complications of transradial access procedures, which include spasm, catheter kinking, and arterial dissection or perforation, may lead to patient discomfort, increased procedure time, and a higher rate of access site cross over. Post-procedural complications such as radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve injury could lead to patient discomfort and limb dysfunction. When radial access site complications occur, comprehensive evaluation and prompt treatment is necessary to reduce long-term consequences. In this report, we review the incidence, clinical factors, and management strategies for radial access site complications associated with cardiac catheterization.
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Sgueglia GA, Hassan A, Harb S, Ford TJ, Koliastasis L, Milkas A, Zappi DM, Navarro Lecaro A, Ionescu E, Rankin S, Said CF, Kuiper B, Kiemeneij F. International Hand Function Study Following Distal Radial Access: The RATATOUILLE Study. JACC Cardiovasc Interv 2022; 15:1205-1215. [PMID: 35595672 DOI: 10.1016/j.jcin.2022.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Distal radial access (DRA) has been proposed to improve procedure ergonomics and favor radial artery patency. Although promising data, nothing is known on evolving hand function after DRA. OBJECTIVES This study sought to comprehensively evaluate hand function in patients undergoing DRA. METHODS Real-world patients undergoing DRA undertook a thorough multimodality assessment of hand function implementing multidomain questionnaires (Disabilities of the Arm, Shoulder and Hand and Levine-Katz), and motor (pinch grip test) and sensory (Semmes-Weinstein monofilaments test) examinations of both hands. All assessments were performed at preprocedural baseline and planned at 1-, 6-, and 12-month follow-up (FU). Adverse clinical and procedural events were documented too. RESULTS Data of 313 patients (220 men, age 66 ± 10 years) from 9 international centers were analyzed. The Disabilities of the Arm, Shoulder and Hand and the Levine-Katz scores slightly improved from baseline to FU (P = 0.008 and P = 0.029, respectively). Pinch strength mildly improved from baseline to FU (P < 0.001 for both the left and right hands). Similarly, touch pressure threshold appeared to faintly improve in both the left and right hands (P < 0.012 for all the sites). For both motor and sensory function tests, comparable findings were found for the DRA hand and the contralateral one, with no significant differences between them. Repeated assessment of all tests over all FU time points similarly showed lack of worsening hand function. Access-related adverse events included 19 harmless bleedings and 3 forearm radial artery and 3 distal radial artery occlusions. None affected hand function at FU. CONCLUSIONS In a systematic multidimensional assessment, DRA was not associated with hand function impairment. Moreover, DRA emerges as a safe alternative vascular access.
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Affiliation(s)
| | - Ahmed Hassan
- Cardiology Department, St. Jansdal Hospital, Harderwijk, the Netherlands; Hartdokters, Amsterdam, the Netherlands
| | - Stefan Harb
- University Heart Center, Medical University of Graz, Graz, Austria
| | - Tom J Ford
- Gosford Hospital, Gosford, New South Wales, Australia
| | | | | | | | | | | | - Stephen Rankin
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Bibi Kuiper
- Independent Researcher, Bussum, the Netherlands
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Zwaan E, Cheung E, IJsselmuiden A, Holtzer C, Schreuders T, Kofflard M, Alings M, Coert JH. Predictive Value of the (Quick)DASH Tool for Upper Extremity Dysfunction Following Percutaneous Coronary Intervention. Patient Relat Outcome Meas 2022; 13:145-155. [PMID: 35783347 PMCID: PMC9249092 DOI: 10.2147/prom.s353895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eva Zwaan
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elena Cheung
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
- Correspondence: Elena Cheung, Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands, Tel +31 88 755 6954, Email
| | | | - Carlo Holtzer
- Department of Plastic and Reconstructive Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ton Schreuders
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marcel Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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5
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The Impact of Using a Larger Forearm Artery for Percutaneous Coronary Interventions on Hand Strength: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10051099. [PMID: 33800778 PMCID: PMC7961765 DOI: 10.3390/jcm10051099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 01/14/2023] Open
Abstract
(1) Background: The exact mechanism underlying hand strength reduction (HSR) after coronary angiography with transradial access (TRA) or transulnar access (TUA) remains unknown. (2) Methods: This study aimed to assess the impact of using a larger or smaller forearm artery access on the incidence of HSR at 30-day follow-up. This was a prospective randomized trial including patients referred for elective coronary angiography or percutaneous coronary intervention. Based on the pre-procedural ultrasound examination, the larger artery was identified. Patients were randomized to larger radial artery (RA) or ulnar artery (UA) or a group with smaller RA/UA. The primary endpoint was the incidence of HSR, while the secondary endpoint was the incidence of subjective HSR, paresthesia, and any hand pain. (3) Results: We enrolled 200 patients (107 men and 93 women; mean age 68 ± 8 years) between 2017 and 2018. Due to crossover between TRA and TUA, there were 57% (n = 115) patients in larger RA/UA and 43% (n = 85) patients in smaller RA/UA. HSR occurred in 29% (n = 33) patients in larger RA/UA and 47% (n = 40) patients in smaller RA/UA (p = 0.008). Subjective HSR was observed in 10% (n = 12) patients in larger RA/UA and 21% (n = 18) patients in smaller RA/UA (p = 0.03). Finally, paresthesia was noted in 7% (n = 8) patients in larger RA/UA and 22% (n = 15) in smaller RA/UA (p = 002). Independent factors of HSR were larger RA/UA (OR 0.45; 95% CI, 0.24-0.82; p < 0.01) and the use of TRA (OR 1.87; 95% CI, 1.01-34; p < 0.05). (4) Conclusions: The use of a larger artery as vascular access was associated with a lower incidence of HSR at 30-day follow-up.
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van Leeuwen MAH, van der Heijden DJ, Hollander MR, Mulder MJ, van de Ven PM, Ritt MJPF, Kiemeneij F, van Mieghem NM, van Royen N. ACRA Perfusion Study. Circ Cardiovasc Interv 2020; 12:e007641. [PMID: 30929508 DOI: 10.1161/circinterventions.118.007641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Transradial intervention (TRI) may impair digital perfusion with hand dysfunction as a result. However, the effect of TRI on digital perfusion has never been investigated, including the influence of variations of the collateral arterial network and the effect on hand dysfunction. METHODS AND RESULTS We investigated the effect of TRI on digital perfusion by laser Doppler perfusion imaging. Laser Doppler perfusion imaging was performed at baseline, during radial access, TR band application, and at discharge. We compared tissue perfusion of the homolateral thumb (access site) with the contralateral thumb (comparator) during radial access as primary outcome. The hand circulation was assessed with angiography. Upper extremity function was evaluated with the validated QuickDASH questionnaire at baseline and follow-up. A significant reduction of tissue perfusion was observed during radial access and TR band application in the homolateral thumb (-32%, -32%, respectively) and contralateral thumb (-34%, -21%, respectively). We detected no perfusion difference between the homolateral and contralateral thumb during radial access (217; interquartile range, 112-364 versus 209; interquartile range, 99-369 arbitrary flux units; P=0.59). Reduced perfusion of the thumb during radial access was not associated with incompleteness of the superficial palmar arch ( P=0.13). Digital perfusion improved at discharge, though it remained below baseline levels (homolateral -11% and contralateral -14%). Hand dysfunction at 18 months was not associated with TRI-induced perfusion reduction ( P=0.54). CONCLUSIONS TRI is safe. Digital perfusion is reduced in both hands during radial access and TR band application but is not associated with future loss of hand function and variations of the arterial hand supply.
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Affiliation(s)
- Maarten A H van Leeuwen
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands (D.J.v.d.H.)
| | - Maurits R Hollander
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Mark J Mulder
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.)
| | - Marco J P F Ritt
- Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Ferdinand Kiemeneij
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | | | - Niels van Royen
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 332] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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Jovin IS, Rajab M. Arm Pain after Transradial Coronary Procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:726-727. [DOI: 10.1016/j.carrev.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
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Kedev S. Approaching the post-femoral era for coronary angiography and intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:910-911. [PMID: 30415970 DOI: 10.1016/j.carrev.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University St. Cyril & Methodius, Skopje, Macedonia.
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Ayyaz Ul Haq M, Rashid M, Gilchrist IC, Bertrand O, Kwok CS, Wong CW, Mansour HM, Baghdaddy Y, Nolan J, van Leeuwen MAH, Mamas MA. Incidence and Clinical Course of Limb Dysfunction Post Cardiac Catheterization - A Systematic Review. Circ J 2018; 82:2736-2744. [PMID: 30249925 DOI: 10.1253/circj.cj-18-0389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We systematically reviewed the available literature on limb dysfunction after transradial access (TRA) or transfemoral access (TFA) cardiac catheterization. METHODS AND RESULTS MEDLINE and EMBASE were searched for studies evaluating any transradial or transfemoral procedures and limb function outcomes. Data were extracted and results were narratively synthesized with similar treatment arms. The TRA group included 15 studies with 3,616 participants and of these 3 reported nerve damage with a combined incidence of 0.16% and 4 reported sensory loss, tingling and numbness with a pooled incidence of 1.61%. Pain after TRA was the most common form of limb dysfunction (7.77%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or neuropathy was low at 0.49%. Although radial artery occlusion (RAO) was not a primary endpoint for this review, it was observed in 3.57% of the participants in a total of 8 studies included. The TFA group included 4 studies with 15,903,894 participants; the rates of peripheral neuropathy were 0.004%, sensory neuropathy caused by local groin injury and retroperitoneal hematomas were 0.04% and 0.17%, respectively, and motor deficit caused by femoral and obturator nerve damage was 0.13%. CONCLUSIONS Limb dysfunction post cardiac catheterization is rare, but patients may have nonspecific sensory and motor complaints that resolve over a period of time.
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Affiliation(s)
- Muhammad Ayyaz Ul Haq
- Keele Cardiovascular Research Group, Keele University
- Department of Cardiology, University Hospital of North Midlands
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University
- Department of Cardiology, University Hospital of North Midlands
| | - Ian C Gilchrist
- Division of Interventional Cardiology, MS Hershey Medical Center, Penn State University, College of Medicine, Heart & Vascular Institute
| | | | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University
- Department of Cardiology, University Hospital of North Midlands
| | - Chun Wai Wong
- Keele Cardiovascular Research Group, Keele University
- Department of Cardiology, University Hospital of North Midlands
| | | | | | - James Nolan
- Keele Cardiovascular Research Group, Keele University
- Department of Cardiology, University Hospital of North Midlands
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University
- Department of Cardiology, University Hospital of North Midlands
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Maki KA, Griza DS, Phillips SA, Wolska BM, Vidovich MI. Altered Hand Temperatures Following Transradial Cardiac Catheterization: A Thermography Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:496-502. [PMID: 30078631 DOI: 10.1016/j.carrev.2018.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is concern about potential detrimental effects of transradial access (TRA) on radial artery structure, endothelial and hand function. This thermography study evaluated TRA impact on hand microvascular perfusion. METHODS AND RESULTS We prospectively measured hand thermography, radial and ulnar artery size and blood flow velocities in both catheterization and non-catheterization hands at baseline and 30-days after TRA in 158 patients. There were no differences in radial or ulnar arterial diameters or velocities pre- and post-TRA in catheterization and non-catheterization hands (p = NS). The absolute total hand thermography values post-TRA were increased in both catheterization and non-catheterization hand (pre-TRA 30.4 ± 2.9 vs. post-TRA 31.6 ± 2.6 p < 0.01; pre-TRA 30.2 ± 2.9, post-TRA 31.6 ± 2.6 p < 0.01, respectively). After ulnar artery occlusion, hand temperatures decreased in both catheterization and non-catheterization hands, both pre- and post-TRA and were similar in the catheterization and non-catheterization hands (p = NS). Total hand temperature decreased with ulnar artery occlusion and was significantly attenuated post-TRA (p < 0.001 both catheterization and non-catheterization hands). CONCLUSIONS TRA is associated with temperature changes in both catheterization and non-catheterization hands at one month after the index procedure. These changes likely represent a systemic response to local TRA stimulus.
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Affiliation(s)
- Katherine A Maki
- Jesse Brown VA Medical Center, Chicago, IL, United States of America; College of Nursing, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Decebal S Griza
- Jesse Brown VA Medical Center, Chicago, IL, United States of America
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Beata M Wolska
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, IL, United States of America; Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Mladen I Vidovich
- Jesse Brown VA Medical Center, Chicago, IL, United States of America; Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States of America.
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van Leeuwen MAH, Hollander MR, van der Heijden DJ, van de Ven PM, Opmeer KHM, Taverne YJHJ, Ritt MJPF, Kiemeneij F, van Mieghem NM, van Royen N. The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access): A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005753. [PMID: 29127118 DOI: 10.1161/circinterventions.117.005753] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown. METHODS AND RESULTS The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77). CONCLUSIONS Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization.
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Affiliation(s)
- Maarten A H van Leeuwen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Maurits R Hollander
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Peter M van de Ven
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Kim H M Opmeer
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Yannick J H J Taverne
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Marco J P F Ritt
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Ferdinand Kiemeneij
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Nicolas M van Mieghem
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Niels van Royen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.).
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Ramírez Vélez A, Gaviria Valencia S, Jaramillo Gómez N, Contreras Martínez H, Cardona Vélez J. Accesos vasculares femoral y radial en intervenciones coronarias percutáneas en síndrome coronario agudo y enfermedad crónica inestabilizada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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14
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Ayyaz Ul Haq M, Nazir SA, Rashid M, Kwok CS, Mubashiruddin S, Alisiddiq Z, Shoaib A, Ratib K, Mamas MA, Nolan J. Accelerated patent hemostasis using a procoagulant disk; a protocol designed to minimize the risk of radial artery occlusion following cardiac catheterization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:137-142. [PMID: 29891428 DOI: 10.1016/j.carrev.2018.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Radial artery occlusion flowing cardiac catheterisation has been linked to flow reduction and prolonged compression. We investigate whether these factors can be optimised following transradial cardiac catheterisation by using an accelerated band removal protocol facilitated by a haemostasis promoting pad, in combination with a patent haemostasis technique. METHODS In this single centre prospective study, 389 consecutive patients undergoing TRA for coronary angiography or angioplasty were randomised to two haemostasis protocols: use of a Helix™ compression device alone (HC) or in combination with a haemostatic pad (StatSeal® disc) and an accelerated haemostasis protocol (AC). A patent haemostasis technique was employed in both study arms. The primary efficacy endpoint was the time to haemostasis and the secondary safety outcome was access site related complications: re-bleeding, haematoma and radial artery patency assessed within 24 h using reverse Barbeau's Test (BT). RESULTS Between May and Nov 2017, 191 patients were randomised to receive HC and 198 patients to AC. Compression time was significantly higher with HC as compared to AC (165.8 ± 63.1 versus 79.7 ± 41.2 min, p < 0.001). There were no significant differences in re-bleeding and RAO between groups (3.7% versus 5.6%, p = 0.37 and 6.3% versus 4.1%, p = 0.33) respectively. Incidence of haematoma was higher in AC group (4.7% versus 12.1%, p = 0.009). CONCLUSION A reduction in radial artery compression time can be achieved by using Statseal in association with an accelerated haemostasis protocol without increasing the risk of access site bleeding and RAO. The combination of reduced compression time combined with maintained radial flow via patent haemostasis has the potential to reduce the risk of radial occlusion after transradial catheterisation.
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Affiliation(s)
- Muhammad Ayyaz Ul Haq
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Sheraz A Nazir
- University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Syed Mubashiruddin
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Zaheer Alisiddiq
- University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Ahmed Shoaib
- University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Karim Ratib
- University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom
| | - James Nolan
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom.
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15
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Chatterjee A, Hillegass WB. Patient preference: An important emerging factor in operator access site selection. Catheter Cardiovasc Interv 2018; 91:25-26. [DOI: 10.1002/ccd.27457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Arka Chatterjee
- Cardiovascular Division, University of Alabama at Birmingham; Birmingham Alabama
| | - William B. Hillegass
- Cardiovascular Division, University of Alabama at Birmingham; Birmingham Alabama
- Department of Biostatistics; University of Alabama at Birmingham; Birmingham Alabama
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16
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Hahalis G, Aznaouridis K, Tsigkas G, Davlouros P, Xanthopoulou I, Koutsogiannis N, Koniari I, Leopoulou M, Costerousse O, Tousoulis D, Bertrand OF. Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta-Analys IS) Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.005430. [PMID: 28838915 PMCID: PMC5586412 DOI: 10.1161/jaha.116.005430] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Incidence of radial artery occclusions (RAO) and ulnar artery occclusions (UAO) in coronary procedures, factors predisposing to forearm arteries occlusion, and the benefit of anticoaggulation vary significantly in existing literature. We sought to determine the incidence of RAO/UAO and the impact of anticoagulation intensity. Methods and Results Meta‐analysis of 112 studies assessing RAO and/or UAO (N=46 631) were included. Overall, there was no difference between crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4–6.0 versus 4.0%; 95% CI, 2.8–5.8; P=0.171). The early occlusion rate (in‐hospital or within 7 days after procedure) was higher than the late occlusion rate. The detection rate of occlusion was higher with vascular ultrasonography compared with clinical evaluation only. Low‐dose heparin was associated with a significantly higher RAO rate compared with high‐dose heparin (7.2%; 95% CI, 5.5–9.4 versus 4.3%; 95% CI, 3.5–5.3; Q=8.81; P=0.003). Early occlusions in low‐dose heparin cohorts mounted at 8.0% (95% CI, 6.1–10.6). The RAO rate was higher after diagnostic angiographies compared with coronary interventions, presumably attributed to the higher intensity of anticoagulation in the latter group. Hemostatic techniques (patent versus nonpatent hemostasis), geography (US versus non‐US cohorts) and sheath size did not impact on vessel patency. Conclusions RAO and UAO occur with similar frequency and in the order of 7% to 8% when evaluated early by vascular ultrasonography following coronary procedures. More‐intensive anticoagulation is protective. Late recanalization occurs in a substantial minority of patients.
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Affiliation(s)
| | - Konstantinos Aznaouridis
- Hippokration Hospital, Athens Medical School, Athens, Greece.,Castle Hill Hospital, Cottingham, United Kingdom
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17
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Ul Haq MA, Rashid M, Kwok CS, Wong CW, Nolan J, Mamas MA. Hand dysfunction after transradial artery catheterization for coronary procedures. World J Cardiol 2017; 9:609-619. [PMID: 28824791 PMCID: PMC5545145 DOI: 10.4330/wjc.v9.i7.609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/16/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To sythesize the available literature on hand dysfunction after transradial catheterization.
METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized.
RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction (6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included.
CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel.
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18
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Hollander M, van Leeuwen M, van der Heijden D, Keizer V, van de Ven P, IJsselmuiden S, Van Mieghem N, Amoroso G, Ritt M, Knaapen P, van Royen N. Non-invasive assessment of the collateral circulation in the hand: validation of the Nexfin system and relation to clinical outcome after transradial catheterisation. EUROINTERVENTION 2017; 12:1773-1781. [DOI: 10.4244/eij-d-16-00337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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van Leeuwen M, van der Heijden D, Hermie J, Lenzen M, Selles R, Ritt M, Kiemeneij F, Zijlstra F, Van Mieghem N, van Royen N. The long-term effect of transradial coronary catheterisation on upper limb function. EUROINTERVENTION 2017; 12:1766-1772. [DOI: 10.4244/eij-d-15-00395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Segrest JH, Hillegass WB. Radial Access Optimization in the Nascent Post-Adoption Era. Catheter Cardiovasc Interv 2016; 88:1044-1045. [PMID: 27976546 DOI: 10.1002/ccd.26864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/06/2022]
Abstract
Post-procedural upper extremity dysfunction (UED) remains one of the few potential questions about the overall benefits of the transradial approach (TRA) to endovascular procedures compared to femoral (TFA). Data on UED is limited, but the most comprehensive study curiously shows similar incidence of post-procedural UED with TFA as TRA. The effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) study will investigate whether patient characteristics influence radial access outcomes such as UED. ARCUS may herald a post-radial-adoption era of more detailed strategies for radial access optimization, typical of a maturing technology.
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Affiliation(s)
| | - William B Hillegass
- Heart South Cardiovascular Group, Alabaster, Alabama.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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21
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Costa F, van Leeuwen MAH, Daemen J, Diletti R, Kauer F, van Geuns RJ, Ligthart J, Witberg K, Zijlstra F, Valgimigli M, Van Mieghem NM. The Rotterdam Radial Access Research: Ultrasound-Based Radial Artery Evaluation for Diagnostic and Therapeutic Coronary Procedures. Circ Cardiovasc Interv 2016; 9:e003129. [PMID: 26839392 DOI: 10.1161/circinterventions.115.003129] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radial artery wall might be damaged after cannulation for cardiac catheterization. We investigated structural changes of the radial artery wall after catheterization to understand whether these might predict radial pulsation loss or occlusion and local pain or functional impairment of the upper extremity. METHODS AND RESULTS Ninety patients underwent transradial coronary angiography or intervention and were scanned with a high-resolution 40-MHz ultrasound before cannulation and at 3 hours and 30 days after procedure. Acute injuries of the radial artery occurred in all patients: dissection and intramural hematoma were the most common. However, these phenomena did not predict loss of radial pulsation or occlusion, local pain, or functional impairment at 30 days. Overall, the radial artery lumen was significantly reduced distal to the puncture site. Radial artery intima and total wall thickness increased 3 hours after puncture and persisted at 30 days. Radial occlusion and pulsation loss were observed in 3.9% and 9.2% of patients, respectively, at 30 days. Smaller radial artery lumen at baseline increased the risk of radial pulsation loss at 30 days (odds ratio, 1.23; P=0.049). The number of radial puncture attempts predicted pulsation loss (odds ratio, 2.64; P=0.027), occlusion (odds ratio, 3.49; P=0.022), and symptoms (odds ratio, 2.24; P=0.05) at 30-day follow-up. CONCLUSIONS After catheterization, radial artery puncture site is associated with increased intima and total wall thickness and with modest decrease of inner lumen diameter. Acute injuries of the vessel wall were ubiquitous, but contrary to repeated puncture attempts, did not seem to affect postprocedural radial occlusion or loss of pulsation.
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Affiliation(s)
- Francesco Costa
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Maarten A H van Leeuwen
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Joost Daemen
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Roberto Diletti
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Floris Kauer
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Robert-Jan van Geuns
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Jurgen Ligthart
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Karen Witberg
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Felix Zijlstra
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Marco Valgimigli
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.)
| | - Nicolas M Van Mieghem
- From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
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22
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Roy AK, Garot P, Louvard Y, Neylon A, Spaziano M, Sawaya FJ, Fernandez L, Roux Y, Blanc R, Piotin M, Champagne S, Tavolaro O, Benamer H, Hovasse T, Chevalier B, Lefèvre T, Unterseeh T. Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions. J Endovasc Ther 2016; 23:880-888. [DOI: 10.1177/1526602816665617] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions. Methods: A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud’s disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared. Results: FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12). Conclusion: The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.
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Affiliation(s)
- Andrew K. Roy
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Phillipe Garot
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Antoinette Neylon
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Marco Spaziano
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Fadi J. Sawaya
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Leticia Fernandez
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Yann Roux
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Raphael Blanc
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
- Department of Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Michel Piotin
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
- Department of Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | | | - Oscar Tavolaro
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Hakim Benamer
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Thierry Unterseeh
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
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Beutel BG, Lifchez SD, Melamed E. Neurovascular Complications of the Upper Extremity Following Cardiovascular Procedures. J Hand Microsurg 2016; 8:65-9. [PMID: 27625533 DOI: 10.1055/s-0036-1585057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Cardiovascular procedures are common and are trending toward endovascular interventions. With this increase in endovascular procedures, there is also increasing awareness of upper extremity morbidity resulting from treatment. METHODS Articles indexed within PubMed between the years 1975 and 2015 that discussed such complications were reviewed. RESULTS Percutaneous radial artery access can lead to nerve ischemia, especially in the setting of an incomplete arterial arch, whereas radial artery harvesting for bypass surgery more commonly causes frank tissue ischemia and radial neuropathy. Transulnar catheterization may cause ischemic hand injuries, while transbrachial angiography has resulted in compartment syndrome. Injuries to the nerves themselves often result from surgical equipment, such as sternal retractors, or from patient positioning leading to compression of the ulnar nerve. For percutaneous radial artery access, the incidence of ischemic injury is as high as 24%, whereas nerve injury is too rare to be estimated. In the setting of radial artery harvesting, ischemic injury is limited to case reports, and radial neuropathy is estimated to occur in as many as 25% of patients at discharge. Open heart surgery is the primary setting in which equipment or patient positioning plays a role, affecting 10% of patients with brachial plexus injuries and 15% with ulnar neuropathies. CONCLUSION Complications following cardiovascular interventions are varied and are typically associated with specific procedures. Careful preoperative and postoperative assessments of patients may aid in preventing, minimizing, and treating these often undiagnosed complications.
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Affiliation(s)
- Bryan G Beutel
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, United States
| | - Scott D Lifchez
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Eitan Melamed
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, United States
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24
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Sawaya FJ, Louvard Y, Spaziano M, Morice MC, Hage F, El-Khoury C, Roy A, Garot P, Hovasse T, Benamer H, Unterseeh T, Chevalier B, Champagne S, Piechaud JF, Blanchard D, Cormier B, Lefèvre T. Short and long-term outcomes of alcohol septal ablation with the trans-radial versus the trans-femoral approach: A single center-experience. Int J Cardiol 2016; 220:7-13. [PMID: 27372037 DOI: 10.1016/j.ijcard.2016.06.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the trans-radial approach (TR) has been applied to various subsets of patients in percutaneous coronary intervention, the feasibility, efficacy, acute procedural and long-term outcomes of TR versus trans-femoral approach (TF) for alcohol septal ablation (ASA) have not yet been determined. OBJECTIVES The aim of this study was to compare the short and long-term outcomes of ASA with the TR approach compared to the TF approach. METHODS We retrospectively analyzed 240 patients who underwent an ASA procedure at our institution from November 1999 to November 2015. The TR approach was performed in 172 cases and the TF approach in the remaining 68 cases. RESULTS The use of TR approach progressively increased from 62% in 1999-2005 to 91% in 2011-2015 (p=0.0001). The TF and TR group had similar age, baseline NYHA class (NYHA 3 or 4) and mean left ventricular outflow tract peak gradient before ASA. Total contrast used (TR: 73.2±47.2ml; TF: 88.7±49.3ml, p=0.11), total radiation Air kerma area product (TR: 43.7±48.0Gycm(-2); TF: 55.9±48.2Gycm(-2); p=0.39) and peak left ventricular outflow tract gradient immediately after ASA (TR: 19.1±19.6mmHg; TF: 20.4±18.0mmHg, p=0.63) were similar in both groups. Procedural success was 91.9% and 91.2% in the TR and TF groups, respectively (p=0.53). At 30days, there was 2 intra-hospital death (1 in TF and 1 in TR), 1 major stroke in the TF group and 1 coronary artery dissection in the TR group. Vascular complications were less frequent in the TR group (0.58% vs. 7.3%; p=0.002). The mean length of follow-up was 4.56±4.34years (IQR 0.69-8.2; median 2.92years; maximum: 15.5years). By Kaplan-Meier estimate, the observed survival in the overall cohort was comparable to the expected survival for a sex and age-matched comparable general French population at 10years (86.9 vs. 83.6%, p=0.88). Survival was similar between the TR and TF group (92.1% vs. 89.7% at 6years, respectively; p=0.71). CONCLUSIONS Alcohol septal ablation from the radial approach can be performed with similar acute and long-term success, but with lower vascular complications compared to the femoral approach.
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Affiliation(s)
- Fadi J Sawaya
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Marco Spaziano
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Marie-Claude Morice
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Fouad Hage
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Carlos El-Khoury
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Andrew Roy
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Philippe Garot
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Hakim Benamer
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Thierry Unterseeh
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Stéphane Champagne
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Jean-François Piechaud
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Didier Blanchard
- Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Bertrand Cormier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud-Hôpital Privé Jacques Cartier, Massy, France.
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Goswami R, Oliphant CS, Youssef H, Morsy M, Khouzam RN. Radial Artery Occlusion After Cardiac Catheterization: Significance, Risk Factors, and Management. Curr Probl Cardiol 2016; 41:214-227. [DOI: 10.1016/j.cpcardiol.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- A Azzano
- Cardiovascular Centre, Antwerp Hospital Network, Lindendreef 1, 2020, Antwerp, Belgium
| | - P Vermeersch
- Cardiovascular Centre, Antwerp Hospital Network, Lindendreef 1, 2020, Antwerp, Belgium.
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27
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Hassell MECJ, Piek JJ. Upper-extremity dysfunction following transradial percutaneous procedures: an overlooked and disregarded complication? Neth Heart J 2015; 23:510-3. [PMID: 26437969 PMCID: PMC4608925 DOI: 10.1007/s12471-015-0749-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- M E C J Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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28
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Rao SV, Kedev S. Approaching the post-femoral era for coronary angiography and intervention. JACC Cardiovasc Interv 2015; 8:524-6. [PMID: 25819182 DOI: 10.1016/j.jcin.2014.12.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina.
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University of St. Cyril & Methodius, Skopje, Macedonia
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