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C atheter Manipulation

C omprehensive A pproach. R adial Cannulation. A orta access. PCR 2003. A rterial compression. C atheter Manipulation. hamon-m@chu-caen.fr. Spasm Haematoma Fistula False anevrysm Causalgia Rupture. R adial Cannulation. Spasm Haematoma Delayed Haematoma. Loops.

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C atheter Manipulation

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  1. Comprehensive Approach Radial Cannulation Aorta access PCR 2003 Arterial compression Catheter Manipulation hamon-m@chu-caen.fr

  2. Spasm • Haematoma • Fistula • False anevrysm • Causalgia • Rupture Radial Cannulation

  3. Spasm • Haematoma • Delayed Haematoma Loops Subclavian artery Aorta access Catheter Manipulation Brachial artery (Proximal) Brachial artery (Distal) Radial artery

  4. Spasm • Haematoma Loops Variations of radio-ulnar anastomoses (Right arm) Left Trans-Radial Approach Aorta access Catheter Manipulation

  5. Spasm • Haematoma High take off of radial artrey: Axillary origin of the radial artery 1 1 2 3 4 Aorta access Catheter Manipulation 3 - 4 varieties -

  6. Forearm haematoma Leeches Aorta access Catheter Manipulation

  7. 1. Right subclavian artery • 2. Brachiocephalic trunk • 3. Right common carotid artery • 4. Right vertebral artery • 5. Right internal thoracic artery • Spasm • Haematoma • Stroke 3 4 1 2 • Exchange wire (260 cm) • J tip, 0.032" • Fluoroscopic guidance   5 Aorta access Catheter Manipulation

  8. Haematoma • Stroke Arteria lusoria 99.75% 0.25% Arteria lusoria: Retroesophageal right subclavian artery Aorta access Catheter Manipulation

  9. Sheath Removal: Compression • Spasm • Haematoma • Causalgia • Rupture • Eversion • Ischemia Radial compression Negative Allen test: contraindication for TRA

  10. Zuma 2 Medtronic • Spasm • Haematoma • Causalgia • Rupture • Eversion • Hand ischemia Radial artery occlusion Radial compression Dahm JB et al. Cathet Cardiovasc Intervent 2002

  11. Year 2000 All procedures Learning curve Femoral 1269 Radial 1108 100 80 60 40 20 Learning curve 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Department of Interventional Cardiology University Hospital of Caen, Normandy, France

  12. Year 2001 All procedures Femoral 396 Radial 2072 Success of TRA 100 80 60 40 20 Success of TRA 0 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Department of Interventional Cardiology University Hospital of Caen, Normandy, France

  13. Femoral Radial PCI and TRA 100 83% 80 (n=1056) 60 53% 47% Percentage % (n=565) 40 (n=507) 17% PCI and TRA 20 (n=221) 0 An 2000 An 2001 Department of Interventional Cardiology University Hospital of Caen, Normandy, France

  14. Others Leeches Transfusions Surgery Randomized studies: Access Study, Kiemeneij F Carafe study, Louvard Y An attempt to obtain zero access site complication 3,0 2.7% 2,5 2,0 P<0.000005 P<0.03 % 1,5 1.1% 1,0 0.3% 0.2% 0,5 Impact 0,0 n=1269 n=1108 n=396 n=2072 Femoral Radial Femoral Radial 2000 2000 2001 2001 Department of Interventional Cardiology University Hospital of Caen, Normandy, France

  15. Rare or anecdoctal complications after radial access (non exhaustive list) Haematoma at the vascular access site Haematoma at the level of forearm (small collateral effraction) Arteriovenous fistula False anevrysm Causalgia (due to nerve injury during arterial puncture) Refractory spasm during and delayed after the procedure (painful) Radial artery eversion during sheath removal Hand ischemia (radial occlusion and no collateral circulation) Delayed haemorrhage (a few days) Conclusion

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