The Disaster of Trans-Radial Intervention Operator: Radial Artery Occlusion and Hand Ischemia.

1. The Disaster of TRI Operator:
Radial Artery Occlusion and
Hand Ischemia
Shenyang Northern Hospital
Wang shouli

4. Duplication of brachial artery (3%)

5. Anomalies of Brachial Artery
Isolated
persistence High origin High origin Duplicity
of the of the of the of the
median artery ulnar artery Radial artery brachial artery
R IMU R I U R I U R I U
I = common intercosseous artery; M = median artery;
R = radial artery; U = Ulnar artery

6. New Procedure – New
Complication
Amorphous material
Possibly polymer
Surrounded by chronic
Inflammatory cells
30 / 1063 ,2.8%
Kozak et al. CCI 2003

7. rates of RAO
local complications of angiography:1!3%;
Angiotheraphy:1!5% (Heintzen MP, Herz. 1998;23:4)
RAO:5% (Saito S, et al. Catheter Cardiovasc Interv. 1999 ;46:37 )
RAO:5/220,2.2% (Jang-Young Kim,et al.Yonsei Medical
J.2005;46:503)
8F 14.3%;7F 6.52%;6F 0.43% (Kikuchi, et al.Jpn J
Iinterv Cardiol 2000,15:343)

8. Radial Artery Flow During Conventional Hemostasis
and Radial Artery Occlusion at Follow-up(7-days)
Preserved flow Absent flow P
at follow-up at follow-up value
(n=246) (n=29)
Absent flow before sheath 120(49%) 15(54%) 0.41
removal
Absent flow after placing 155(63%) 19(66%) 0.49
hemostatic bandages
Absent flow before removing 132(54%) 26(90%) 0.0001
hemostatic bandages(2 hr)
Absent flow after hemostatic 34(13%) 15(54%) 0.0001
bandages
Marcelo Sanmartin,et al. Catheterization and Cardiovascular Interventions
70:185(2007)

9. Radial artery flow was absent in 174 cases
(174/275,62%) immediately after entry-site
compression
After 2 hr of conventional hemostasis, radial
artery flow was absent in 162 cases (58%)
before bandage removal
At 7-day follow-up, 12 patients (4.4%) had
absent pulsations and radial artery flow was
absent in 29 cases (10.5%)
Marcelo Sanmartin,et al. Catheterization and Cardiovascular
Interventions 70:185(2007)

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Stella PR, et al. Cathet Cardiovasc Diagn. 1997;40:156

11. The clinical symptoms of RAO
pain
cold sensitivity
weakness
tissue death with ulceration and/or necrosis

12. Risk Factors of RAO

13. Naoyuki Yokoyama, et al. Catheter Cardiovasc Interv. 2000 ;49:357

14. Patients with an occluded radial artery at
follow-up had significantly smaller
arterial diameters at baseline (2.23
60.4 mm vs. 2.4060.5 mm;P=0.032)
and more frequently had absent flow
during hemostasis (90% vs. 54%, P
<0.001)
Marcelo Sanmartin,et al. Catheterization and Cardiovascular
Interventions 70:185(2007)

15. Stepwise logistic regression analysis
revealed that absent flow before
compressive bandages removal was
the only independent predictor of radial
artery occlusion at follow-up (OR 5 6.7;
IC 95%: 1.95-22.9; P 5 0.002).
Marcelo Sanmartin,et al. Catheterization and Cardiovascular
Interventions 70:185(2007)

16. Incidence and risk factors of acute RAO following
transradial percutaneous coronary intervention
Acute RA0 occulted in 68 patients(68/7215,0.94
7). more female and DM patients
The dosage of heparine used in the operational
procedure in RAO group were significantly
less than normal group(3723 IU6556 IU VS
7603 IU61533 IU8P<0.01)
The post--procedure duration of high--pressure
compression hemostais were longer in RA0
patients than normal patients(103.8 min 6
23.3 min VS 87.7 min631.2min8P= 0.02)
Zhou YJ,et al.Natl Med J China, June 12,2007;87:1531

17. Logistic regression analyses showed
that the dosage of heparine used in the
procedure9the category and size of
sheath and the post—procedure
compression time were independent
risk factors for RA0
Zhou YJ,et al.Natl Med J China, June 12,2007;87:1531

18. Treatment and
Prevention of RAO

19. RAO surgical treatment
David S. Ruch,et al. J Hand Surg 2000;25A:282

20. David S. Ruch,et al. J Hand Surg 2000;25A:282

21. Pre-
operation
Post-
operation
David S. Ruch,et al. J Hand Surg 2000;25A:282

22. Pre-
operation
Post-
operation
David S. Ruch,et al. J Hand Surg 2000;25A:282

23. The incidence of RAO can be minimized
by appropriate anticoagulation, proper
sheath selection, and avoiding
prolonged durarion of high-pressure
compression hemostasis following the
procedure
Zhou YJ,et al.Natl Med J China, June 12,2007;87:1531

24. Thanks