Management and timing of access-site vascular complications occurring after trans-radial percutaneous coronary procedures

Francesco Burzotta, Carlo Trani, Giovanni Tinelli, Filippo Crea, Luca Mariani, Valentina Coluccia, Marta Francesca Brancati, Italo Porto, Antonio Maria Leone, Giampaolo Niccoli, Antonella Tommasino, Mario Attilio Mazzari, Rocco Mongiardo, Francesco Snider, Giovanni Schiavoni

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16 Citations (Scopus)

Abstract

Background: Access-site vascular complications (ASVC) in patients undergoing trans-radial coronary procedures are rare but may have relevant clinical consequences. Data regarding the optimal management of radial-access-related ASVC are lacking. Methods: During a period of 6 years we prospectively collected ASVC. ASVC were defined as any complication requiring ultrasound examination or upper limb angiography. ASVC were categorized according to the timing of diagnosis: "very early" (in the cath lab), "early" (after cath lab discharge, but during the hospital stay) and "late" (after hospital discharge). The need of surgery (primary end-point) and the development of neurological hand deficit (secondary end-point) were assessed. Results: Fifty-seven radial-artery related ASVC were collected. ASVC diagnosis was obtained by upper limb angiography in 25 patients (44%) and by Doppler in 32 patients (56%). Surgery was required in 6 cases (11%), the remaining patients receiving successful conservative management (which included prolonged local compression). Three patients (who received surgery) exhibited a mild neurological hand deficit in the follow-up. Need for surgery differed significantly according to timing of diagnosis as it occurred in 1 of 26 patients (3.8%) with "very early" diagnosis, in 1 of 21 patients (4.8%) with "early" diagnosis, and in 4 of 10 patients (40%) with "late" diagnosis (p = 0.026). Conclusions: ASVC are diagnosed with different timing after trans-radial procedures. Conservative management including local compression allows successful management in the majority of ASVC. Prompt recognition is pivotal as late diagnosis is associated to the need for surgery.
Original languageEnglish
Pages (from-to)1973-1978
Number of pages6
JournalINTERNATIONAL JOURNAL OF CARDIOLOGY
DOIs
Publication statusPublished - 2012

Keywords

  • PCI
  • Trans-radial approach

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