Upper extremity vascular complications following transradial approach for cardiac catheterization and intervention: A focused review of diagnostic, prognostic and therapeutic considerations

Cardiac catheterization using the transradial approach has dramatically increased in worldwide adoption since its original description almost thirty years ago. Over the past decade, a groundswell of contemporary clinical data has demonstrated the superiority of the transradial approach over transfemoral catheterization with respect to bleeding and vascular complications, time to ambulation, length of hospital stay, healthcare economics, as well as patient comfort and satisfaction. In addition, large multicenter clinical trials have demonstrated trends in mortality reduction with the transradial compared to transfemoral approach in high risk patients undergoing percutaneous coronary intervention for ST-segment elevation myocardial infarction. As enthusiasm for the transradial approach has grown, the technique has expanded to more complex applications and patient subsets beyond those initially studied. Concerns regarding the risk of vascular complications following transradial procedures persist and questions regarding the safety and feasibility of repeated radial access have been raised. This article reviews various complications of the upper extremity associated with the transradial approach for catheter-based interventions. We discuss the vascular changes following radial artery cannulation, and describe in detail the incidence, risk factors, identification, and treatment of radial artery spasm, radial artery occlusion, radial pseudoaneurysm, radiobrachial perforation, forearm hematomas and compartment syndrome, hand ischemia, and radial artery avulsion. This review serves as a practical guide to the common and uncommon complications of the upper extremity that the contemporary transradial operator may be faced with.