Limb function, sensation not impinged by radial artery access

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 - transradial, wrist

Chalk another one up for transradial access. According to results published online March 26, patients undergoing catheterization via the radial artery had no significant change to limb function and sensation, assessed by cold intolerance, was not adversely impacted.

The study, published in the Journal of the American College of Cardiology: Cardiovascular Interventions ran between 2013 and 2014. Physicians assessed upper limb function for 338 patients undergoing ambulatory coronary catheterization. Transradial access comprised 85 percent of the cohort.

Maarten A.H. van Leeuwen, MD, of the VU University Medical Center in Amsterdam, and colleagues used a series of questionnaires before catheterization and at the 30-day follow-up to assess cold intolerance and upper limb function. Sex and age did play a role in initial limb-function questionnaire scores, with female and elderly patients reporting less upper limb function than males and patients younger than 75.

However, upper limb function remained relatively similar before and after catheterization, regardless of point of entry. They also noted that the number of procedure-related extremity complaints at 30-days was, likewise, similar. Cold intolerance scores did not change over time. Further, cold intolerance could not be associated with access route: 6.3 percent of transradial patients and 7.7 percent of transfemoral patients expressed sensitivity to cold at follow-up.

They noted a lack of patent dual palmar arch circulation in 8 percent of patients, according to an Allen test, and 6.2 percent assessed by Barbeau test. However, no association was observed between loss of upper extremity function, cold intolerance, patency and abnormal vascular communication.

Sunil V. Rao, MD, of the Duke Clinical Research Institute in Durham, N.C, and Sasko Kedev, MD, PhD, of the University of St. Cyril & Methodius in Skopje, Macedonia, commented that these and other recent findings challenge transfemoral access. “It is clear that, from the available evidence, radial access not only improves clinical outcomes and reduces costs, but also has no adverse effects on arm and hand function,” they wrote.

Van Leeuwen et al wrote that future research would focus on transradial access in patients with abnormal dual arterial supply.