Uhlemann M et al have reported radial access site complications in their prospective vascular ultrasound registry [The Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization. Impact of Sheath Size on Vascular Complications. JACC Cardiovasc Interv. 2012; 5:36-43]. The primary objective of the study was to find the impact of sheath size on the chance of radial artery occlusion. They evaluated over four hundred and fifty patients between 2009 and 2010. Duplex ultrasound studies were done in all patients before discharge.
Symptomatic radial artery occlusions were treated with low molecular weight heparin. Total access site vascular complication rate was 14.4 percent with a 5 F sheath and 33.1 percent with a 6 F sheath. Occlusion of the radial artery occurred in 13.7 percent with 5F sheaths and 30.5 percent with 6 F sheath. Other access site complications assessed in the study were hemorrhage, pseudoaneurysm, arteriovenous fistula. 42.5 percent of the radial artery occlusions were immediately symptomatic while seven percent became symptomatic within a mean of four days. Recanalization rates were higher in those who received low molecular weight heparin (55.6% vs. 13.5%, p < 0.001) after a mean period of 14 days. The incidence of radial artery occlusions noted by ultra sound evaluation in this study was surprisingly high, more so in those whom a larger sheath had been deployed.