Complications of Transradial Approach - Duke Clinical Research ...
Complications of Transradial Approach - Duke Clinical Research ...
Complications of Transradial Approach - Duke Clinical Research ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Complications</strong> <strong>of</strong> <strong>Transradial</strong><strong>Approach</strong>Olivier F. Bertrand, MD, PhDAssociate-Pr<strong>of</strong>essor <strong>of</strong> Medicine, Laval UniversityAdjunct-Pr<strong>of</strong>essor, Department <strong>of</strong> Mechanical Engineering, McGill UniversityQuebec Heart-Lung InstituteDUKE TRANSRADIAL ADVANCED COURSE20 OCTOBER 2011Friday, October 21, 2011
Disclosures<strong>Research</strong> grants (IIT): Cordis, Eli-Lilly,Bristol-Myers-Squibb,GE Healthcare,San<strong>of</strong>i-Aventis, EurocorConsultant: Cordis, Astra-Zeneca,Opsens<strong>Research</strong>-Scholar from QuebecFoundation for Health <strong>Research</strong>Friday, October 21, 2011
Upper Limb VascularizationFUJII ET AL. J INV CARDIOL 2010;22:536-40Friday, October 21, 2011
Types <strong>of</strong> Vascular<strong>Complications</strong>-CommonTypes Radial FemoralHematoma > 5cmPseudo-aneurysmA/V FistulaSkin infectionDissection/RuptureThrombosisDistant BleedingNerve InjuryAtherosclerosis< 1% 3-5%< 1%
Types <strong>of</strong> Vascular<strong>Complications</strong>-SpecificTypesCompartment syndromeSpasmArtery avulsionGranulomatous skin reactionDigital ischemiaTransient vocal cord paralysisMediastinal hematomaDelayed reflex sympatheticdystrophyCatheter entrapmentRadial< 1‰< 1%< 1‰case-reportcase-reportcase-reportcase-reportcase-reportcase-reportFriday, October 21, 2011
SpasmLack <strong>of</strong> definition...No brachial artery spasm...look for recurrent artery..Prevention >> TreatmentRisk factors: Smoking, small vessel, anxietyPharmaco: Calcium channel blockers or comboDevices: Small sheath, hydrophylic, sheathlessIf severe: sedation ± sympathetic blockCOURTESY G BARBEAUFriday, October 21, 2011
Pseudo-aneurysmCOLLINS ET AL. CCI 2011True incidence probably underestimatedImportance <strong>of</strong> timing for diagnostic...Risk factors: hypertension, chronic anticoagulation,types <strong>of</strong> closure devices ?Rx: compression, echo-guided thrombin injection,NO surgeryFriday, October 21, 2011
Friday, October 21, 2011Dissection <strong>of</strong> Radial Artery
Immediate Post-PCIAngiogramSame-day transfer toreferring centerNo HematomaFriday, October 21, 2011
Friday, October 21, 2011
Friday, October 21, 2011
Friday, October 21, 2011
Friday, October 21, 2011
Friday, October 21, 2011
Bleeding at Distance fromPuncture SiteFriday, October 21, 2011
Nursing ManagementEASY Hematoma Classification after <strong>Transradial</strong>/Ulnar PCIRadialUlnar5 cmI10 cmIIforearmIIIarmIVGRADE I IIINCIDENCE ≤ 5% < 3%< 2% ≤ 0.1% < 0.01%IIIIVVDEFINITIONLocal hematoma,superficialHematomawith moderatemuscular infiltrationForearm hematomaand muscular infiltration,below the elbowHematoma and muscularinfiltration extendingabove the elbowIschemic threat(compartment syndrome)TREATMENTAnalgesiaAdditional braceletLocal iceAnalgesiaAdditional braceletLocal iceAnalgesiaAdditional braceletLocal iceInflated BP cuffAnalgesiaAdditional bracelet,Local iceInflated BP cuffConsider surgeryNOTES Inform physician Inform physician Inform physician STAT call to physicianREMARKS- Control blood pressure (BP) (importance <strong>of</strong> pain management)- Consider interruption <strong>of</strong> any anticoagulation and/or antiplatelet infusion- Follow forearm and arm diameters to evaluate requirement for additional bracelet and/or BP cuff inflation- Additional bracelet(s) can be placed alongside artery anatomy- Ice cubes in a plastic bag or washcloth are placed on the hematoma- Finger O 2saturation can be monitored during inflated blood pressure cuff- To inflate blood pressure cuff, select a pressure <strong>of</strong> 20 mmHg < systolic pressure and deflate every 15 minutes- After bracelet removal, use “Velpeau bandage” around forearm/arm for a few hours to maintain mild positive pressureBertrand et al. Circulation 2006;114(24):2646-53©Hôpital Laval 2002Friday, October 21, 2011
Friday, October 21, 2011
Prevention !!!!TIZON H, BARBEAU G, J INTERV CARDIOL 2008Friday, October 21, 2011
Friday, October 21, 2011Radial Artery Occlusion
Friday, October 21, 2011Radial Artery Occlusion
Radial Artery OcclusionBERNAT I ET AL. AM J CARDIOL 2011 (IN PRESS)Friday, October 21, 2011
Friday, October 21, 2011Retrograde Recanalization
Friday, October 21, 2011Retrograde Recanalization
Friday, October 21, 2011QHLI: <strong>Clinical</strong> Outcomes
Friday, October 21, 2011Post Retrograde Recanalization
Friday, October 21, 20111 Week Post-Recanalization
Friday, October 21, 2011Catheter Entrapment...
Friday, October 21, 2011
Friday, October 21, 2011Radial vs Catheter Selection ?
Conclusion<strong>Complications</strong> <strong>of</strong> radial approach have beenwell documentedMost are preventableOptimization still required for hemostasis andprevention/treatment <strong>of</strong> RAOIssue <strong>of</strong> coronary dissection ie single cathetermanipulation needs to be exploredFriday, October 21, 2011
Québec City (Québec) CanadaSeptember 7-9, 2011COURSE DIRECTOR:Olivier F. Bertrand MD, PhD, FSCAIWITH LIVE CASES FROM:Institut universitaire de cardiologieet de pneumologie de Québec (IUCPQ)Interventional Cardiology LabsSUPPORTED BY:Université Laval - <strong>Transradial</strong><strong>Approach</strong> <strong>Research</strong> & Education Fund<strong>Transradial</strong> <strong>Approach</strong><strong>Research</strong> & Education FundFollow us on Facebookat The_radialist_clubFriday, October 21, 2011
Change language