No Diclosures. M. Uhlemann, S. Gielen, G.C. Schuler Department of Internal Medicine/Cardiology University of Leipzig, Heart Center, Germany

Transcription

1 Routine vascular ultrasound after radial artery catheterization detects clinically silent access site complications: Prospective registry of 425 consecutive patients M. Uhlemann, S. Gielen, G.C. Schuler Department of Internal Medicine/Cardiology University of Leipzig, Heart Center, Germany No Diclosures

2 Metaanalysis of 23 Randomized Clinical Trials Comparing Radial versus Femoral Access Reduction of Major Bleeding P<0.001 No Effect on Mortality Jolly SS, Am Heart J 2009;157:132-40

3 Aim of Study Evaluation of the frequency of access site complications after using 5F or 6F sheaths detected by postprocedural vascular ultrasound How often do patients with radial artery occlusion show symptoms? Management of patients presenting with radial artery occlusion?

4 Methods and Material 6 French- and 5 French vascular sheaths with and without hydrophilic coating 2500 IU of unfractionated heparin for diagnostic angiography, 100 IU/kg bodyweight of unfractionated heparin for percutaneous intervention Nitroglycerin 0.2 mg intravenously Compression device (RadiStop/ Terumo) routine vascular ultrasound of the access site within 24 hours after each procedure

5 Baseline Characteristics (n= 425 consecutive patients) Age (years, mean ± SD) 64.9 ± 10.9 Male gender (n, %) 267 (62.8) Body mass index (kg/m², mean ± SD) 29.3 ± 5.6 Hypertension (n, %) 407 (95.8) Diabetes mellitus (n, %) 141 (33.2) Dyslipidaemia (n, %) 297 (69.8) Current smoking (n, %) 70 (16.5) Coronary artery disease (n, %) 224 (52.7) Acute coronary syndrome (n, %) 31 ( 7.3) PCI (n, %) 63 (14.8) Cerebrovascular disease (n, %) 39 ( 9.2) Peripheral vascular disease (n, %) 42 ( 9.9) LV-EF (%, mean ± SD) 56.7 ± 10.9

6 Number of patients Incidence of Local Access Site Complications % 25.4 % % 0.9 % Total events Occlusion Pseudoaneurysm AV-Fistula

7 Incidence of Access Site Complications dependent on the size of the sheath Number of patients * 32.6% % F 6 F sheath complications 5 F 6 F sheath no events *p< F vs 6F sheaths

8 Number of patients Number of patients Vascular Complications after Transradial Access 5 F- vs. 6 F- Sheaths Number of patients AV-Fistula Radial artery occlusion 1% 0.8% 3 5F sheaths 6F sheaths 60 Pseudoaneurysm 1% % 13.4% F sheaths 6F sheaths * F sheaths 3 6F sheaths 3 *p< F vs. 6F sheaths

9 Number of patients Incidence of Local Bleeding Complications % * 1.3% F sheaths 6 F sheaths Minor Bleeding No evidence of major bleeding P= (ns)

10 Number of patients Clinical Symptoms of Radial Artery Occlusion (n= 107) % 45.8% symptomatic asymptomatic

11 Predictors for Radial Artery Occlusion P-Value OR 95% C.I. for OR Lower Upper 6F Sheath 40 < Younger Age Female Gender <

12 Management of Patients with Radial Artery Occlusion Symptomatic patients: - LMWH in bodyweight-adjusted dose or - LMH in half-therapeutic dose (if ASS+Clopidogrel) Asymptomatic patients: - no heparin was given Follow-up vascular ultrasound after 7 ( and 14) days

13 Influence of LMWH on Reperfusion Rates % LMWH * 14.3% No LMWH *p=0.001 LMWH vs. no LMWH

14 Study Limitations No randomized study design Moderate sample size Single center study No preinterventional sonography Real world scenario (unselected patients)

15 Summary Even though radial access for coronary procedures was successful in reducing major bleeding compared to femoral access, the rate of radial artery occlusions detected by prospective vascular ultrasound examination was higher than expected. Use of 5F-sheaths significantly decreases the rate of radial artery occlusions. Younger age and female gender are strong predictors for radial artery occlusion. 46% of patients with vascular occlusion were symptomatic. In symptomatic patients anticoagulation with LMWH resulted in a significantly higher reperfusion rate.

16 Conclusion Clinical examination (inspection, paplation, auscultation) is insufficient and insensitive to detect all vascular access site complications We therefore propose routine vacular ultrasound after each procedure

17 Thank you for your kind attention! The old university buildings The new campus