There has been a great transition in arterial access in cardiac catheterization, from brachial cut downs (Mason Sone’s technique) to femoral artery puncture with sheaths, and now, radial artery access through the wrist and snuffbox (back hand approach). The radial artery approach is fast becoming the standard approach for the majority of cardiac catheterizations.
In their article “Hand dysfunction after transradial artery catheterization for coronary procedures,”1 Ul Haq et al review available studies from Medline and Embase, and attempt to assess the impact of hand dysfunction after radial access for coronary procedures. They define hand dysfunction as disability, grip strength change, power loss, pain, vascular complications. A total of 13 studies were selected after reviewing 555 results of transradial studies (yes, 542 studies were not relevant.) These 13 reviews harvested 3815 cases. The authors’ findings concluded a very low incidence of hand dysfunction after cardiac catheterization, and that most symptoms resolved without clinical follow-up.
Pain was the highest complaint, at 108 events (6.67%). Vascular complications came in second, at 54 events (3.06%). Radial artery occlusion came in third, at 40 events (2.41%). Sensory loss was found in 29 events (1.52%). Hand function was recorded in 4 events (0.26%). Nerve damage was reported in one instance (0.16%).
This all sounds very promising. Yet as the authors report, “The quality of the evidence describing these complications is poor, as many studies are underpowered and do not report any events.” The majority of the studies relied on subjective reporting of patients rather than quantifiable measurements. There is, at this time, no standard method of measuring radial artery access, extraction, and/or post-care trauma.
The evaluation of the hand and wrist prior to radial access tends to be limited to an Allen’s test or, less frequently, a Barbeau test. Not documented are measurements of grip strength, flexibility, and tactile dexterity, pre and post procedure and post recovery.
I concur with the authors’ call for future studies to report complications of radial access, and their disappointment in how past studies have poorly described or not reported radial access complications or events. The article was enjoyable and the tables well presented, particularly the presentation of the questionnaires. The authors’ references were up to date and relevant.
Complications are uncomfortable and scary for our patients. Now is the time to focus on how to avoid radial artery complications in the future, and how to quickly respond and treat complications appropriately when they do occur. I would highly recommend readers take the time to read and review their own protocol and procedures for radial artery access recovery and reporting. Let’s share knowledge and protocols, and raise our standards.
- Ul Haq MA, Rashid M, Kwok CS, et al. Hand dysfunction after transradial artery catheterization for coronary procedures. World J Cardiol. 2017 Jul 26;9(7):609-619. doi: 10.4330/wjc.v9.i7.609.