Transradial cardiac catheterization—an in vivo procedure that can diagnose and treat many heart conditions—could be causing permanent damage to blood vessels, a study published in the Journal of Cardiac Surgery suggests.

Lead author of the study Alexios S. Antonopoulos, MD, PhD, and colleagues sorted through the PubMed database for studies exploring the effects of the procedure, which involves inserting a long, thin tube through the arm’s radial artery to reach the heart, on blood vessel health.

An exhaustive review of 12 eligible studies, published between the beginning of PubMed’s existence and April of 2017, led Antonopoulos and co-authors to believe transradial catheterization can have a long-lasting, detrimental effect on cells in the radial artery for months after surgery. These cells might not ever recover, the authors wrote.

While a significant reduction in endothelium-dependent response was observed in all instances of post-catheterization, meta-analysis of the data showed that male gender, as well as increased time after the procedure, were linked to less artery dysfunction.

In their study, Antonopoulos and colleagues noted these findings may limit the use of the radial artery as a conduit during these common surgeries, including coronary artery bypass graft surgery, because of poor endothelial function.