The Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization: Impact of Sheath Size on Vascular Complications
What is the impact of sheath size on access site complications in patients undergoing radial artery catheterization?
The authors enrolled 455 patients who underwent radial catheterization at their institution in a prospective registry. Of the cohort, 5-F sheaths were used in 153 and 6-F sheaths in 302 patients. Duplex sonography was obtained in each patient before discharge. Patients with symptomatic radial artery occlusion (RAO) were treated with low molecular weight heparin (LMWH), and a follow-up study was performed.
RAO (detected on Doppler) occurred in 13.7% with 5-F sheaths compared with 30.5% with 6-F sheaths (p < 0.001). In 22 patients (19.5%) with ultrasonographic signs of RAO, the radial artery pulse was still palpable. The overall access site complication rate was 14.4% with 5-F sheaths compared with 33.1% with 6-F sheaths (p < 0.001). Three patients developed a pseudoaneurysm in the 6-F group (1.0%), whereas none was observed in the 5-F group. Two of these patients were treated with ultrasound-guided compression, whereas one patient required a surgical repair. Arteriovenous fistulas were detected in three patients (1.0%) in the 6-F group and in one patient (0.7%) in the 5-F group. Female sex, larger sheath size, peripheral arterial occlusive disease, and younger age were independent predictors of RAO. Of the patients with RAO, 42.5% were immediately symptomatic, whereas another 7% became symptomatic within a mean of 4 days. The majority (59%) of patients with RAO were treated with LMWH, and the recanalization rates were significantly higher in patients receiving LMWH compared with conventional therapy (55.6% vs. 13.5%, p < 0.001).
In this prospective registry of patients undergoing radial catheterization, radial artery occlusion was seen in a large number of patients on routine ultrasonic surveillance and was more common in those treated with 6-F sheaths.
Radial catheterization is associated with a significantly reduced risk of access site bleeding and is increasingly seeing an uptake in the United States. This study suggests that the incidence of local complications with radial access may be higher than previously recognized, and further refinement of the technique may be necessary to make this a safer procedure.
Keywords: Aneurysm, False, Incidence, Follow-Up Studies, Ultrasonics, Radial Artery, Cardiology, Heparin, Low-Molecular-Weight, Catheterization, Hemorrhage, United States
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