ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 11 of 42
УЖМБС 2020, 5(2): 84–90
Clinical Medicine

Vascular Complications in Percutaneous Transluminal Coronary Angioplasty associated with Transradial Access and their Prevention

Aksenov E. V. 1, Mikhailova А. V. 2

The work deals with assessing the frequency of spasm a. radialis arising from percutaneous coronary angioplasty with access through the radial artery using the modified method of prevention and treatment of this complication. Material and methods. The study included 703 patients who were performed diagnostic and therapeutic interventions for coronary heart disease in the X-ray angiographic departments of the N. Amosov, National Academy of Medical Sciences of Ukraine and State Institution “Institute of the Heart of the Ministry of Health of Ukraine” (Kiev, Ukraine) from February 2017 to March 2019. From the total number of people under observation we selected a group of patients who used a modified method of prevention and treatment of a. radialis procedural spasm (ultrasound evaluation of the sizes of a. radialis, for the optimal selection of the introducer sheath appropriate; in case of a spasm of a. radialis patients were given unfractionated heparin in dose of 50-70 U / kg directly to the radial artery and intra-arterial “cocktail”, which consisted of 5 mg of verapamil in combination with 200 μg nitroglycerin in 10 ml of physiological saline). The average age of the patients was 67.7 ± 10.2 years; people older 75 years were 25.3%. The average weight was 86.5 ± 1.44 kg (from 67 kg to 102 kg). There were 67.1% of men among the observed contingent. Results and discussion. As a result of the performed studies, it was determined that during the endovascular angiographic procedures with transradial access the spasm of the radial artery was fixed in 35 patients (4.98% of cases). To prevent a. radialis spasm during transradial access, it was necessary to select a guiding catheter in such a way that the ratio of internal diameter a. radialis and external diameter of the catheter was ≥ 1.0. Early radial artery occlusion (defined as radial artery occlusion 24 hours after the procedure) was recorded in 12.4% of cases (12 patients) in group II, compared with 5.95% of cases (5 patients) in group I (p = 0.0014). Conclusion. When using a modified methodology for the prevention and treatment of complications associated with transradial access, there was a decrease in pain sensation in the area of a. radialis puncture and forearms by 19.7%, a decrease in the mean pain score on a visual-analogue scale by 32.8±4.3%, and a decrease in the percentage of a. radialis early and chronic occlusion.

Keywords: vascular complications, transradial access, X-ray angiographic procedures

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