A 63-year-old woman develops progressive pain, tenderness, and discoloration in the right wrist within several days of undergoing a cardiac catheterization using a radial artery approach. Her examination is remarkable for a tender, ecchymotic, and pulsatile protuberance along the distal radial artery. The right hand and fingers are warm and without distal embolic phenomena. Sensorimotor function of the right upper extremity is intact, and the forearm muscle compartments are soft. A duplex arterial ultrasound of the affected area documents a 1.5-cm pseudoaneurysm involving the distal radial artery.
Brachial artery access is declining for coronary angiography but still holds an important role for complex endovascular interventions, particularly in cases of concomitant severe peripheral artery disease. The majority of brachial access is achieved percutaneously, with a small minority of cases requiring brachial cutdown.
Transradial artery access for cardiac catheterization is widely embraced in Europe and increasingly is being adopted in the United States as a potentially safer means of access than the conventional transfemoral approach.
Brachial artery access site complications occur in up to 7% of cases. In a review of 323 cases using brachial artery access, the first and second most common complications were pseudoaneurysm and brachial artery thrombosis, respectively (Figures 12-1,12-2, and 12-3).1
This relatively high complication rate is probably a function of low operator volume and declining experience in this access over the transradial approach.
Radial artery catheterization is typically associated with a complication rate between 0.5% and 15%.2,3 However, the incidence may be higher than reported due to excellent collateral circulation supplying the hand. For instance, in a 2012 prospective ultrasound-assisted registry, radial access complications developed in 33% of patients when a 6F sheath was utilized.4
Duplex ultrasound study illustrating a markedly increased peak systolic velocity (PSV = 419 cm/s) due to subtotal thrombotic brachial artery occlusion following brachial access for an endovascular procedure.
Power Doppler examination illustrating the typical "Yin and Yang" color findings of a brachial artery pseudoaneurysm.
Digital subtraction arteriogram of a postcatheterization asymptomatic brachial artery occlusion with extensive collaterals.
ETIOLOGY AND PATHOPHYSIOLOGY
Potential complications of brachial artery access include pseudoaneurysm, hematoma, bleeding, thrombotic occlusion, distal emboli, infection, dissection, and arteriovenous fistula.
Brachial artery pseudoaneurysm is the most commonly encountered complication (Figure 12-2).1
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessCardiology Full Site: One-Year Subscription
Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.
Pay Per View: Timed Access to all of AccessCardiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.