The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications
Madlen Uhlemann, Sven Möbius-Winkler, Meinhard Mende, Ingo Eitel, Georg Fuernau, Marcus Sandri, Volker Adams, Holger Thiele, Axel Linke, Gerhard Schuler, Stephan Gielen, Madlen Uhlemann, Sven Möbius-Winkler, Meinhard Mende, Ingo Eitel, Georg Fuernau, Marcus Sandri, Volker Adams, Holger Thiele, Axel Linke, Gerhard Schuler, Stephan Gielen
Abstract
Objectives: This study investigated the impact of sheath size on the rate of radial artery occlusions (RAO) (primary objective) and other access site complications (hemorrhage, pseudoaneurysm, arteriovenous fistula) as secondary objectives after transradial coronary catheterization.
Background: The number of vascular access complications in the published data ranges from 5% to 38% after transradial catheterization.
Methods: Between November 2009 and August 2010, 455 patients 65.3 ± 10.9 years of age (62.2% male) with transradial access with 5-F (n = 153) or 6-F (n = 302) arterial sheaths were prospectively recruited. Duplex sonography was obtained in each patient before discharge. Patients with symptomatic RAO were treated with low-molecular-weight heparin (LMWH), and a follow-up was performed.
Results: The incidence of access site complications was 14.4% with 5-F sheaths compared with 33.1% with 6-F sheaths (p < 0.001). Radial artery occlusion occurred in 13.7% with 5-F sheaths compared with 30.5% with 6-F sheaths (p < 0.001). There was no difference between groups with regard to hemorrhage, pseudoaneurysms, or arteriovenous fistulas. Female sex, larger sheath size, peripheral arterial occlusive disease, and younger age independently predicted RAO in multivariate analysis. In total, 42.5% of patients with RAO were immediately symptomatic; another 7% became symptomatic within a mean of 4 days. Of patients with RAO, 59% were treated with LMWH. The recanalization rates were significantly higher in patients receiving LMWH compared with conventional therapy (55.6% vs. 13.5%, p < 0.001) after a mean of 14 days.
Conclusions: The incidence of RAO by vascular ultrasound was higher than expected from previous data, especially in patients who underwent the procedure with larger sheaths.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed