Author + information
- Arnold Seto, MD, MPA⁎ ()
- ↵⁎University of California, Irvine Medical Center, 101 The City Drive, Orange, California 92868
Uhlemann et al. (1) serve all transradial operators with a warning flag regarding the incidence of radial artery occlusion (RAO). Their systematic use of ultrasound to assess for radial artery patency goes above and beyond the typical practice of pulse checks or plethysmography. However, their RAO rates of 13.7% in 5-F sheaths and 30.5% in 6-F sheaths far exceed the rates seen clinically or in recent trials, including those with routine ultrasound screening (2).
A few details are missing that would aid in the interpretation of these results. The duration of radial compression was described as 3 h when this report was presented in abstract form, but was not specified in the publication. RAO was diagnosed by the absence of flow by color Doppler ultrasound, but it is unclear whether this was confirmed by the more sensitive technique of pulse-wave Doppler (where a reversal of flow can be demonstrated). The color Doppler signal in the small radial artery may also be absent if: 1) the ultrasound probe is perpendicular to the direction of flow; 2) excessive pressure is applied; 3) flow is present but reduced in velocity; or 4) the sensitivity is set improperly. Patients with RAO by ultrasound should presumably demonstrate abnormal digital oximetry with ulnar compression—a concordance with this finding would have been helpful.
The use of ultrasound in radial artery catheterization both before and after the procedure should be encouraged. Ultrasound can detect anatomic variants, such as dual-radial systems and radial loops, screen for radial artery calcification, and assess the size of the radial artery. Real-time ultrasound use also facilitates successful radial artery puncture (3).
Unfortunately, formal ultrasound screening for RAO by a trained technician costs up to $155 (4), which may reduce or eliminate the $77 and $184 cost advantage that radial access has over femoral access with and without closure devices (5). The true incidence and impact of RAO will determine whether routine ultrasound screening is necessary or cost effective. In particular, if RAO occurs, and neither the patient nor the physician notices, and there may be a >50% chance of recanalization by 30 days without treatment, does it make a sound?
- American College of Cardiology Foundation
- Uhlemann M.,
- Möbius-Winkler S.,
- Mende M.,
- et al.
- Centers for Medicare and Medicaid Services