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Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures.

Zwaan EM, Koopman AG, Holtzer CA, Zijlstra F, Ritt MJ, Amoroso G, Moerman E, Kofflard MJ, IJsselmuiden AA - Neth Heart J (2015)

Bottom Line: Two independent, trained investigators searched MEDLINE, EMBASE and CENTRAL for eligible studies published before 1 January 2015.Also, they hand-searched the conference proceedings of the annual scientific sessions of the American College of Cardiology, the American Heart Association, European Society of Cardiology, and the Trans-catheter Cardiovascular Therapeutics.Optimising TR-PCP might be achieved by using slender techniques, detection of upper extremity dysfunction and early referral to a hand rehabilitation centre.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.

ABSTRACT

Objectives: Little is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity dysfunction after TR-PCP.

Methods: Two independent, trained investigators searched MEDLINE, EMBASE and CENTRAL for eligible studies published before 1 January 2015. Also, they hand-searched the conference proceedings of the annual scientific sessions of the American College of Cardiology, the American Heart Association, European Society of Cardiology, and the Trans-catheter Cardiovascular Therapeutics. Inclusion criteria were cohort studies and clinical trials discussing the incidence of access-site complications and upper extremity function after transradial percutaneous coronary intervention (TR-PCI) and/or transradial coronary angiography (TR-CAG) as endpoints.

Results: 176 articles described access-site complications. The incidence is up to 9.6 %. Fourteen articles described upper extremity dysfunction, with an incidence of up to 1.7 %. Upper extremity dysfunction was rarely investigated, hardly ever as primary endpoint, and if investigated not thoroughly enough.

Conclusion: Upper extremity dysfunction in TR-PCP has never been properly investigated and is therefore underestimated. Further studies are needed to investigate the magnitude, prevention and best treatment of upper extremity dysfunction. Optimising TR-PCP might be achieved by using slender techniques, detection of upper extremity dysfunction and early referral to a hand rehabilitation centre.

No MeSH data available.


Related in: MedlinePlus

The anatomy of the upper extremity (a) and its variations (b). a The anatomy of the arteries (red line) and nerves (grey line) of the arm leading to the heart. The area where the bifurcation of the radial artery might occur is accentuated; this area is prone to perforation (inner dashed box). The area where spasm, occlusion or damage to vasa nervorum occurs is also highlighted (outer dashed box). Hydrophilic guiding catheters and special radial access closure devices might reduce the incidence of these complications and could diminish the impact on upper extremity function. b Frequent variations of the take-off of the radial artery. The radial artery ® and ulnar artery (U) are illustrated. 1. Radial artery arising from the brachial artery. 2. Independent radial artery arising from the axillary artery. 3. Radial artery arising from the axillary artery with a contribution from the brachial artery. 4. Slender artery arising from the axillary artery continuing as the radial artery. The major blood supply to the radial artery is supplied by the brachial artery. This type is highly susceptible to perforation.
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Related In: Results  -  Collection


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Fig1: The anatomy of the upper extremity (a) and its variations (b). a The anatomy of the arteries (red line) and nerves (grey line) of the arm leading to the heart. The area where the bifurcation of the radial artery might occur is accentuated; this area is prone to perforation (inner dashed box). The area where spasm, occlusion or damage to vasa nervorum occurs is also highlighted (outer dashed box). Hydrophilic guiding catheters and special radial access closure devices might reduce the incidence of these complications and could diminish the impact on upper extremity function. b Frequent variations of the take-off of the radial artery. The radial artery ® and ulnar artery (U) are illustrated. 1. Radial artery arising from the brachial artery. 2. Independent radial artery arising from the axillary artery. 3. Radial artery arising from the axillary artery with a contribution from the brachial artery. 4. Slender artery arising from the axillary artery continuing as the radial artery. The major blood supply to the radial artery is supplied by the brachial artery. This type is highly susceptible to perforation.

Mentions: Little is known about the impact of access-site and procedural complications on upper extremity function after transradial percutaneous coronary interventions (TR-PCI) and transradial coronary angiography (TR-CAG) even though the transradial route is quickly becoming the golden standard for many interventional cardiologists [1]. In 2013, over 85 % of all PCIs at our hospital were performed using the radial artery. In comparison, in the third quarter of 2012 only 16.9 % of all PCIs in the USA were performed using this approach [2]. This appreciation of TR-PCI and TR-CAG, summed up under the heading of the transradial percutaneous coronary procedures (TR-PCP), stems from innovations in the field of material science. Refinement of materials, such as hydrophilic sheaths and miniaturisation of equipment, has increased the therapeutic options, thus making TR-PCP elegant, safe and feasible [2–4]. This was confirmed in a comprehensive meta-analysis of randomised clinical trials by Jolly et al. [3]. They compared radial versus femoral access and showed a 73 % reduction in major bleeding and a trend towards reductions of mortality, myocardial infarction and stroke in favour of the radial route [3]. Additionally, TR-PCP is associated with lower costs and higher patient satisfaction, correlating with a higher quality of life [4]. However, TR-PCP is technically more challenging with a long learning curve [5–7], partly due to the complex anatomical variability of the nerves and blood vessels in the upper extremity (Fig. 1; [8–10]) This makes TR-PCP more susceptible to functional complications. To understand the impact of access-site complications and its effect on upper extremity function a clear definition of the latter is needed and this has been much debated. Traditional clinical assessment has focused on grip or pinch strength and range of motion [11, 12]. A much more encompassing definition would be ‘the physiological capacity in which a patient can use an anatomically unaffected upper limb in everyday activities’. To evaluate this, several aspects should be considered. It comprises anatomy, including blood and lymph circulation, muscle strength, active range of motion, coordination and sensory functions. Pain affects all of these parameters (Fig. 2). Adequate knowledge of complications is necessary to prevent dysfunction. Current reviews have not described upper extremity function [13–15]. This study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity dysfunction after TR-PCP.Fig. 1


Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures.

Zwaan EM, Koopman AG, Holtzer CA, Zijlstra F, Ritt MJ, Amoroso G, Moerman E, Kofflard MJ, IJsselmuiden AA - Neth Heart J (2015)

The anatomy of the upper extremity (a) and its variations (b). a The anatomy of the arteries (red line) and nerves (grey line) of the arm leading to the heart. The area where the bifurcation of the radial artery might occur is accentuated; this area is prone to perforation (inner dashed box). The area where spasm, occlusion or damage to vasa nervorum occurs is also highlighted (outer dashed box). Hydrophilic guiding catheters and special radial access closure devices might reduce the incidence of these complications and could diminish the impact on upper extremity function. b Frequent variations of the take-off of the radial artery. The radial artery ® and ulnar artery (U) are illustrated. 1. Radial artery arising from the brachial artery. 2. Independent radial artery arising from the axillary artery. 3. Radial artery arising from the axillary artery with a contribution from the brachial artery. 4. Slender artery arising from the axillary artery continuing as the radial artery. The major blood supply to the radial artery is supplied by the brachial artery. This type is highly susceptible to perforation.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4608927&req=5

Fig1: The anatomy of the upper extremity (a) and its variations (b). a The anatomy of the arteries (red line) and nerves (grey line) of the arm leading to the heart. The area where the bifurcation of the radial artery might occur is accentuated; this area is prone to perforation (inner dashed box). The area where spasm, occlusion or damage to vasa nervorum occurs is also highlighted (outer dashed box). Hydrophilic guiding catheters and special radial access closure devices might reduce the incidence of these complications and could diminish the impact on upper extremity function. b Frequent variations of the take-off of the radial artery. The radial artery ® and ulnar artery (U) are illustrated. 1. Radial artery arising from the brachial artery. 2. Independent radial artery arising from the axillary artery. 3. Radial artery arising from the axillary artery with a contribution from the brachial artery. 4. Slender artery arising from the axillary artery continuing as the radial artery. The major blood supply to the radial artery is supplied by the brachial artery. This type is highly susceptible to perforation.
Mentions: Little is known about the impact of access-site and procedural complications on upper extremity function after transradial percutaneous coronary interventions (TR-PCI) and transradial coronary angiography (TR-CAG) even though the transradial route is quickly becoming the golden standard for many interventional cardiologists [1]. In 2013, over 85 % of all PCIs at our hospital were performed using the radial artery. In comparison, in the third quarter of 2012 only 16.9 % of all PCIs in the USA were performed using this approach [2]. This appreciation of TR-PCI and TR-CAG, summed up under the heading of the transradial percutaneous coronary procedures (TR-PCP), stems from innovations in the field of material science. Refinement of materials, such as hydrophilic sheaths and miniaturisation of equipment, has increased the therapeutic options, thus making TR-PCP elegant, safe and feasible [2–4]. This was confirmed in a comprehensive meta-analysis of randomised clinical trials by Jolly et al. [3]. They compared radial versus femoral access and showed a 73 % reduction in major bleeding and a trend towards reductions of mortality, myocardial infarction and stroke in favour of the radial route [3]. Additionally, TR-PCP is associated with lower costs and higher patient satisfaction, correlating with a higher quality of life [4]. However, TR-PCP is technically more challenging with a long learning curve [5–7], partly due to the complex anatomical variability of the nerves and blood vessels in the upper extremity (Fig. 1; [8–10]) This makes TR-PCP more susceptible to functional complications. To understand the impact of access-site complications and its effect on upper extremity function a clear definition of the latter is needed and this has been much debated. Traditional clinical assessment has focused on grip or pinch strength and range of motion [11, 12]. A much more encompassing definition would be ‘the physiological capacity in which a patient can use an anatomically unaffected upper limb in everyday activities’. To evaluate this, several aspects should be considered. It comprises anatomy, including blood and lymph circulation, muscle strength, active range of motion, coordination and sensory functions. Pain affects all of these parameters (Fig. 2). Adequate knowledge of complications is necessary to prevent dysfunction. Current reviews have not described upper extremity function [13–15]. This study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity dysfunction after TR-PCP.Fig. 1

Bottom Line: Two independent, trained investigators searched MEDLINE, EMBASE and CENTRAL for eligible studies published before 1 January 2015.Also, they hand-searched the conference proceedings of the annual scientific sessions of the American College of Cardiology, the American Heart Association, European Society of Cardiology, and the Trans-catheter Cardiovascular Therapeutics.Optimising TR-PCP might be achieved by using slender techniques, detection of upper extremity dysfunction and early referral to a hand rehabilitation centre.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.

ABSTRACT

Objectives: Little is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity dysfunction after TR-PCP.

Methods: Two independent, trained investigators searched MEDLINE, EMBASE and CENTRAL for eligible studies published before 1 January 2015. Also, they hand-searched the conference proceedings of the annual scientific sessions of the American College of Cardiology, the American Heart Association, European Society of Cardiology, and the Trans-catheter Cardiovascular Therapeutics. Inclusion criteria were cohort studies and clinical trials discussing the incidence of access-site complications and upper extremity function after transradial percutaneous coronary intervention (TR-PCI) and/or transradial coronary angiography (TR-CAG) as endpoints.

Results: 176 articles described access-site complications. The incidence is up to 9.6 %. Fourteen articles described upper extremity dysfunction, with an incidence of up to 1.7 %. Upper extremity dysfunction was rarely investigated, hardly ever as primary endpoint, and if investigated not thoroughly enough.

Conclusion: Upper extremity dysfunction in TR-PCP has never been properly investigated and is therefore underestimated. Further studies are needed to investigate the magnitude, prevention and best treatment of upper extremity dysfunction. Optimising TR-PCP might be achieved by using slender techniques, detection of upper extremity dysfunction and early referral to a hand rehabilitation centre.

No MeSH data available.


Related in: MedlinePlus