Rate of Complications at Early Removal of Compression Bandage After Transradial Coronary Angiography

Purpose: to compare rates of access site complications at early (after 4 hours) and traditional (after 24 hours) removal of a compression bandage after diagnostic transradial (TR) coronary angiography (CA) in patients not receiving anticoagulants.

Materials and methods. We included into this study 392 patients (mean age 63±8.7 years, 62.8% men) who underwent transradial coronary angiography. Patients were divided into 2 groups. In group 1 patients (n=221) compression bandage was removed from puncture site in 4 hours after procedure with subsequent control of radial artery patency using presence of pulse metric curve during ulnar artery compression (the reverse Barbeau test with pulse oximeter). In patients of group 2 (n=171) compression band was removed after 24 hours. In both groups control of radial artery patency was carried out after 24 hours using the reverse Barbeau test. Upon detection of radial artery occlusion (RAO) ultrasound imaging of the forearm arteries was performed.

Results. No RAO was detected in group 1 while in group 2 number of detected RAO was 15 (8.8%) (р<0.05). Rates of hematomas at puncture site were not significantly different. Puncture site bleeding after band removal requiring repeated banding occurred in 1 patient of group one (0.6%); no such cases were registered in group 2 (p>0.05).

Conclusion. Compared with traditional method early removal of compression bandage after TR CA was associated with lower rate of RAO.

1. Louvard Y., Benamer H., Garot P. et al. Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study). Am J Cardiol 2004;94:1177–1180.

2. Agostoni P., Biondi-Zoccai G.G., de Benedictis M.L. et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol 2004;44:349–356.

3. Merkulov E.V., Mironov V.M., Samko A.N. Coronary angiography, ventriculography, bypass angiography in illustrations and schemas. Moscow: Media-Medica 2011; 18. Russian (Коронарная ангиография, вентрикулография, шунтография в иллюстрациях и схемах. Е.В. Меркулов, В.М. Миронов, А.Н. Самко. М.: Медиа Медика 2011;18).

4. Stella P.R., Kiemeneij F., Laarman G.J. et al. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diagn 1997;40:156–158.

5. Pancholy S., Coppola J., Patel T. et al. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET Study): A randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv 2008;72:335–340.

6. Sanmartin M., Gomez M., Rumoroso J.R. et al. Interruption of blood flow during compression and radial artery occlusion after transradial catheterization. Catheter Cardiovasc Interv 2007;70:185–189.

7. Saito S., Ikei H., Hosokawa G. et al. Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention. Catheter Cardiovasc Interv 1999;46:173–178.

8. Dahm J.B., Vogelgesang D., Hummel A. et al. A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions. Catheter Cardiovasc Interv 2002;57:172–176.

9. Wu S.S., Galani R.J., Bahro A. et al. 8 French transradial coronary interventions: clinical outcome and late effects on the radial artery and hand function. J Invasive Cardiol 2000;12:605–609.

10. Pancholy S.B., Bernat I., Bertrand O.F. et al. Prevention of radial artery occlusion after transradial catheterization: the PROPHET-II randomized trial. JACC Cardiovasc Interv 2016;9:1992–1999.

11. Degirmencioglu A., Buturak A., Zencirci E. et al. Comparison of effects of low- versus high-dose heparin on access-site complications during transradial coronary angiography: a double-blind randomized study, Cardiology 2015;131:142–148.

12. Hahalis G., Xathopoulou I., Tsigkas G. et al. A comparison of low versus standard heparin dose for prevention of forearm artery occlusion after 5 French coronary angiography. Int J Cardiol 2015;187:404–410.

13. Bernat I., Bertrand O.F., Rokyta R. et al. Efficacy and safety of transient ulnar artery 6compression to recanalize acute radial artery occlusion after transradial catheterization. Am J Cardiol 2011;107:1698–1701.

14. Plante S., Cantor W.J., Goldman L. et al. Comparison of bivalirudin versus heparin on radial artery occlusion after transradial catheterization. Catheter Cardiovasc Interv 2010;76:654–658.

15. Pancholy S.B. Comparison of the effect of intra-arterial versus intravenous heparin on radial artery occlusion after transradial catheterization, Am J Cardiol 2009;104:1083–1085.

16. Pancholy S.B., Patel T.M. Effect of duration of hemostatic compression on radial artery occlusion after transradial access. Catheter Cardiovasc Interv 2012;79:78-81.

17. Bajaj R., Eltibi R., Benotti J. et al. Inverse modified Allen’s test: an inaccurate predictor of radial artery occlusion compared to Doppler ultrasound after transradial catheterization: case series and review of literature. Ann Vasc Med Re 2015;2:1009.

18. Barbeau G.R., Arsenault F., Dugas L. et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: Comparison with the Allen’s test in 1010 patients. Am Heart J 2004;147:489–493.

19. Pancholy S.B. Transradial access in an occluded radial artery: new technique. J Invasive Cardiol 2007;19:541–544.

20. Dharma S., Kedev S., Patel T. et al. A novel approach to reduce radial artery occlusion after transradial catheterization: postprocedural/ prehemostasis intra-arterial nitroglycerin. Catheter Cardiovasc Interv 2015;85:818–25.

21. Yonetsu T., Kakuta T., Lee T. et al. Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomography. Eur Heart J 2010;31:1608–1615.

22. Hirsh J., Raschke R. Antithrombotic and thrombolytic therapy. The Seventh ACCP Conference on heparin and low-molecular weight heparin. Chest 2004;126:188S–203S.