Radial Artery Occlusion Following Cardiac Catheterization by Conventional Radial Approach versus Distal Radial Approach: Incidence and Predictors

Abstract

Purpose: In comparison to transfemoral approach, transradial access (TRA) has developed to be the conventional entry site and is quickly expanding. Radial artery occlusion (RAO) which can occur during transradial intervention, impairs radial artery (RA) to be the future access site, and prohibits the artery from being used as an arterial conduit. Aim of this research was comparing incidence and predictors of RAO among individuals receiving elective cardiac catheterization by conventional radial access vs distal radial access.
 Methodology: This prospective study enrolled 120 patients from June 2022 to January 2023 (84 males, 36 females; mean age 68.5 (10.4) years with 62 patients had elective cardiac catheterization via conventional radial approach (CRA) and others via distal radial approach (DRA). Clinical follow up at 24 hours and 30 days was recorded with analysis of the incidence and predictors of RAO among all included participants.
 Findings: This study reported no substantial difference among groups in terms of socio-demographic and clinical characteristics. Time to sheath insertion and Procedure time were long among patients who had Distal radial approach with statistically significant difference (P <0.01). Moreover, RAO at 24 hours and 30 days follow up was higher among patients had CRA than those had DRA with no significant difference (P >0.05). This research demonstrated that RAO incidence was significantly high among younger patients, smoker, DM and those with previous CAD. Also, time to sheath insertion and hemostasis were long in patients with RAO with statistically significant difference (P <0.05). Smoking, DM, long Procedure time and increased time to hemostasis with diminished blood supply in wrist throughout hemostasis were strong predictors for radial artery occlusion.
 Recommendations: Maintaining radial patency must be done with all procedures using the radial approach. DRA may be useful to lower RAO incidence through shortening hemostasis time and sustaining radial artery flow during hemostasis. Encouraging the interventional cardiologists for more practicing about utilizing DRA was recommended due to its advantages like safety with less vascular complications.