NEW YORK (Reuters Health) – The rate of radial artery occlusion after transradial catheterization increases with the size of arterial sheath used for the procedure, according to data from a German registry reported in the January issue of JACC: Cardiovascular Interventions.

An editorial, however, questions whether best practices were employed to prevent arterial occlusion.

For their study of the impact sheath size on vascular complications, Dr. Stephan Gielen and colleagues at the University of Leipzig used duplex ultrasound to assess radial artery patency in 455 consecutive patients after undergoing transradial diagnostic angiography and PCI.

The procedure was performed with a 5-F vascular sheath 153 patients and with a 6-F sheath in 302.  Rates of post-procedural radial artery occlusion in the two groups were 13.7% and 33.1%, the authors report.

On multivariate analysis, female sex (odds ratio 2.36), larger sheath size (OR 2.68), peripheral arterial occlusive disease (OR 2.04), and age (OR per year 0.96) were independent predictors of arterial occlusion.

Other access site complications — hemorrhage, pseudoaneurysms, or arteriovenous fistulas — did not differ between the two groups, the report indicates.

Summing up, the team concludes, “The incidence of RAO (radial artery occlusion) by vascular ultrasound was higher than expected from previous data, especially in patients who underwent the procedure with larger sheaths.”

In an editorial, Dr. Sunil V. Rao with the Duke Clinical Research Institute in Durham, North Carolina, writes “RAO is a known risk of transradial catheterization, and the use of RAO-avoidance strategies should be considered ‘best practice’.”

Based on the information in the Leipzig paper, Dr. Rao notes, “It appears that best practices to reduce RAO were not followed in the registry, and the unacceptably high rates of RAO in their study should be interpreted with caution.”

He concludes, “RAO should be recognized as an adverse consequence and routine assessment for postprocedure RAO should be an integral part of a catheterization laboratory’s quality improvement program.”

Meanwhile, another paper in the journal reports the results of an Italian study comparing transradial versus transfemoral intervention in 11,068 patients being treated for acute MI.

As have several previous reports, this study found transradial access superior.  Dr. Marco Valgimigli, at the University of Ferrara, and colleagues report that 2-year mortality rates were lower with the radial approach than with femoral access (8.8% vs 11.4%; p=0.0250), as were vascular complications requiring surgery (1.1% vs 2.5%; p=0.0052).

As Dr. Rao comments in his editorial, “Despite its marked safety advantage, cost-effectiveness, and potential mortality benefit in high-risk patients, compared with the femoral approach, the radial approach is not without limitations.”

The Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization : Impact of Sheath Size on Vascular Complications

Observations From a Transradial Registry : Our Remedies Oft in Ourselves Do Lie

Transradial Versus Transfemoral Intervention for Acute Myocardial Infarction : A Propensity Score-Adjusted and -Matched Analysis From the REAL (REgistro regionale AngiopLastiche dell’Emilia-Romagna) Multicenter Registry

J Am Coll Cardiol Intv 2012;5:36–46, 23–35.