Key result
In patients with suspected radial access complications, arterial lines yielded more positive duplex ultrasound findings than left heart catheterization (79% vs 57%, P=0.007).
Why the study?
Complications requiring intervention after radial artery access may affect future use of the site or bypass harvesting, but their occurrence and associated risk factors needed better definition.
Does radial artery catheter (A-line) placement compared to left heart catheterization (LHC) increase the rate of positive UEAD findings in patients with suspected complications?
Observational (n=131)
No
Does radial artery catheter (A-line) placement compared to left heart catheterization (LHC) increase the rate of positive UEAD findings in patients with suspected complications?
Clinically apparent complications after radial artery access requiring surgical intervention are uncommon, though A-lines are more frequently associated with positive duplex ultrasound findings than left heart catheterization.
Answers are grounded in this paper and cite their sources.
Positive UEAD findings after A-lines should not alter practice; leaves open their link to clinical complications.
Introduction: The radial artery is often utilized for invasive hemodynamic monitoring as well as an access site for arterial and cardiac catheterization. Complications requiring intervention, although uncommon, may have implications for future utilization of this site and harvesting for coronary bypass. We aimed to better define the occurrence and the risk factors associated with radial artery access (RAA). Methods: Patients referred for upper extremity arterial duplex (UEAD) examinations with clinical findings suspicious for complications after RAA between 2008 and 2016 were reviewed. Electronic medical records and vascular laboratory records were reviewed for demographics and peri-procedural data. Results: The radial artery was used for 19,253 arterial lines, and 13,402 cardiac catheterizations during the study period at our institution. During this time, a total of 131 patients were referred to our vascular laboratory for UEAD based on abnormal clinical findings after RAA. Sixty-two (47%) patients had undergone radial artery catheter (A-line) placement for hemodynamic monitoring, and 69 (53%) had left heart catheterization (LHC). Six patients required surgical intervention: 5 after A-line and 1 after LHC. A-line was more frequently associated with a positive UEAD finding compared with LHC (79% vs 57%, P = .007). Among patients with A-lines, there was no significant relationship between presence of a positive UEAD finding and the specialty or level of training of the operator, the number of attempts, the usage of ultrasound guidance, or catheter indwelling time. There was also no significant relationship between a positive UEAD finding and the size of sheath (5Fr vs 6Fr) among patients who underwent LHC. Conclusions: A positive UEAD finding in patients with clinically apparent complications after RAA is uncommon, and the need for surgical intervention is similarly infrequent. Follow-up UEAD studies may be useful to determine long-term patency of the radial artery and usability for future access or for coronary artery bypass grafting.
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Darwazeh et al. (2022) conducted an observational in Complications after radial artery access (n=131). Radial artery catheter (A-line) placement vs. Left heart catheterization (LHC) was evaluated on Positive UEAD finding (p=.007). In patients with suspected radial access complications, arterial lines yielded more positive duplex ultrasound findings than left heart catheterization (79% vs 57%, P=0.007).
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