Bertrand OF_2 201110
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Complications of Transradial Approach
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Bertrand OF_2 201110
- 1. Complications of Transradial Approach Olivier F. Bertrand, MD, PhD Associate-Professor of Medicine, Laval University Adjunct-Professor, Department of Mechanical Engineering, McGill University Quebec Heart-Lung Institute DUKE TRANSRADIAL ADVANCED COURSE 20 OCTOBER 2011 Friday, October 21, 2011
- 2. Disclosures Research grants (IIT): Cordis, Eli-Lilly, Bristol-Myers-Squibb,GE Healthcare, Sanofi-Aventis, Eurocor Consultant: Cordis, Astra-Zeneca, Opsens Research-Scholar from Quebec Foundation for Health Research Friday, October 21, 2011
- 3. Upper Limb Vascularization FUJII ET AL. J INV CARDIOL 2010;22:536-40 Friday, October 21, 2011
- 4. Types of Vascular Complications-Common Types Radial Femoral Hematoma > 5cm < 1% 3-5% Pseudo-aneurysm < 1% <1% A/V Fistula < 1‰ 1-2% Skin infection < 1% <1% Dissection/Rupture < 1% <1% Thrombosis <1%-10% <1% Distant Bleeding - <1% Nerve Injury - <1% Atherosclerosis ? ? Friday, October 21, 2011
- 5. Types of Vascular Complications-Specific Types Radial Compartment syndrome < 1‰ Spasm < 1% Artery avulsion < 1‰ Granulomatous skin reaction case-report Digital ischemia case-report Transient vocal cord paralysis case-report Mediastinal hematoma case-report Delayed reflex sympathetic case-report dystrophy Catheter entrapment case-report Friday, October 21, 2011
- 6. Spasm Lack of definition... No brachial artery spasm...look for recurrent artery.. Prevention >> Treatment Risk factors: Smoking, small vessel, anxiety Pharmaco: Calcium channel blockers or combo Devices: Small sheath, hydrophylic, sheathless If severe: sedation ± sympathetic block COURTESY G BARBEAU Friday, October 21, 2011
- 7. Pseudo-aneurysm COLLINS ET AL. CCI 2011 True incidence probably underestimated Importance of timing for diagnostic... Risk factors: hypertension, chronic anticoagulation, types of closure devices ? Rx: compression, echo-guided thrombin injection, NO surgery Friday, October 21, 2011
- 8. Dissection of Radial Artery Friday, October 21, 2011
- 9. Immediate Post-PCI Angiogram Same-day transfer to referring center No Hematoma Friday, October 21, 2011
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- 15. Bleeding at Distance from Puncture Site Friday, October 21, 2011
- 16. Nursing Management Friday, October 21, 2011
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- 18. Prevention !!!! TIZON H, BARBEAU G, J INTERV CARDIOL 2008 Friday, October 21, 2011
- 19. Radial Artery Occlusion Friday, October 21, 2011
- 20. Radial Artery Occlusion Friday, October 21, 2011
- 21. Radial Artery Occlusion BERNAT I ET AL. AM J CARDIOL 2011 (IN PRESS) Friday, October 21, 2011
- 22. Retrograde Recanalization Friday, October 21, 2011
- 23. Retrograde Recanalization Friday, October 21, 2011
- 24. QHLI: Clinical Outcomes Friday, October 21, 2011
- 25. Post Retrograde Recanalization Friday, October 21, 2011
- 26. 1 Week Post-Recanalization Friday, October 21, 2011
- 27. Catheter Entrapment... Friday, October 21, 2011
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- 29. Radial vs Catheter Selection ? Friday, October 21, 2011
- 30. Conclusion Complications of radial approach have been well documented Most are preventable Optimization still required for hemostasis and prevention/treatment of RAO Issue of coronary dissection ie single catheter manipulation needs to be explored Friday, October 21, 2011
- 31. Follow us on Facebook at The_radialist_club Friday, October 21, 2011