Assessment of the radial artery access site and its use in invasive cardiac procedures

• Main Author: Lo, Ted Su Neng
• Published: Keele University 2013
• Subjects: 616.1; R Medicine (General)
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.721620

Vascular access via the radial artery has recently been shown to reduce access site related vascular complications but is associated with a significant learning curve. Radial artery spasm, arterial puncture failure, vascular anomalies, failure to reach the ascending aorta and concern regarding higher radiation exposure with the transradial are some obstacles that impede widespread uptake of this technique. This study was performed to assess some of these learning curve issues and to explore the use of transradial access in high-risk patient subgroups. Six interlinked projects were setup for this study and a total of 3125 patients evaluated. Access site vascular complications remain unacceptably high in contemporary practice as discussed in Chapter 2. The transradial approach could minimise such complications. Radial artery anomalies are relatively common and are a common cause of transradial procedure failure as detailed in Chapter 3. Forearm arterial diameter variations and the effect of sublingual GTN were discussed in Chapter 4. The radial artery is bigger than the ulnar artery and GTN increases their diameters by an average of 15-22%. The issues with radiation exposure were studied as detailed in Chapter 5. With strict control of various variables and optimal radiation protection, we demonstrated that there is no difference in radiation exposure between transradial and transfemoral diagnostic angiography when performed by an experienced operator. The application of transradial technique in 2 high-risk patient subgroups was analysed as detailed in Chapter 6. Transradial rescue angioplasty for failed reperfusion and percutaneous right and left heart catheterisation via the arm approach without interruption to Warfarin therapy are found to be safe and effective. These findings have important clinical implication and may help shorten the learning curve and optimise procedure technique including high-risk patient subgroups, thereby help to further drive the adoption of transradial approach.