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Radial Artery Access

theheart.org has a short but instructive video discussion on radial access.
Some discussion points:

  • pre-procedural testing: recent trial data suggests that low risk of occlusion and complications even in patients with poor integrity palmar arch assessed Barbos palmar arch testing.
  • procedural:
    • adjunctive heparin reduces risk of radial artery occlusion
    • standard dose of herpain 5000 units but  dose and timing need more evidence
    • some evidence that heparin may be needed in patient’s with therapeutic INR wrt end-point radial artery occlusion
    • use of left radial may be prudent in elderly and patients < 5ft 5 in , female (1.65 m) in addition to graft study patients
    • future directions:
      • ultrasound guidance: increase success puncture and brachial scanning can identify radial loops
      • use of ulnar artery (e.g. after failed radial)
  • post-procedural care:
    • minimal pressure v patency strategies uncertain benefit. Currentl radial artery occlusion rates low.

 

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