K.F.C.LI1, Y.P. LIM1, K. KAVITHA1, S.H. CHING1, C.SUDHA1, J.G.A.FAMADOR1, W.F.WEE1, H.M.LI1, S.K.TAN1, H.H.HO1
Tan Tock Seng Hospital1
Trans-radial approach (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) has superseded trans-femoral approach due to reduced risks of major vascular and bleeding complications. However, there is a need to monitor major TRA complications and elucidate contributory factors.
We evaluated consecutive patients who underwent CAG and PCI via TRA from March to April 2021 in our institution. All patients were reviewed for radial complications on same day and the next day after procedure. Grading of local forearm hematoma is based on the EASY hematoma scale.
181 patients underwent TRA in the audit period. Incidence of radial complications was 5.8% (11 patients) which was mainly attributed to local hematoma. 7 patients (3.7%) had grade 1 hematoma, 2 (1.1%) grade 2 hematoma and 2 (1.1%) grade 3 hematoma. There were no major vascular complications (hand ischemia, artery perforation, arteriovenous fistula formation or compartment syndrome). Local hematoma was managed with manual or bandage compression without any need for surgery. There was no significant correlation with risk factors like body mass index, radial sheath size, number of puncture attempts, vasopressor or glycoprotein IIb/IIIa use.
TRA is a safe approach for performing CAG and PCI with low rates of major bleeding or vascular complications. The lack of significant correlation to underlying risk factors is likely secondary to low incidence of observed complications, which may be addressed by a longer term surveillance. Clinical protocols should be drawn up for the management of vascular or bleeding complications.