Radial Artery Sheath Insertion

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Radial Artery Sheath Insertion

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The radial artery access sheath is used to gain arterial access and facilitate the insertion of catheters or other equipment for diagnostic and vascular interventions. [1]  Compared with procedures performed via the commonly used femoral artery access route, procedures performed via the radial artery route allow shorter recovery time, earlier ambulation, earlier discharge, and lower incidences of access-site complications, as well as being advantageous for patients with occlusive aortoiliac disease or peripheral vascular disease.

However, specific challenges exist in using radial artery sheath access. The radial artery is smaller than the femoral artery, and thus, more finesse and experience are required to access this vessel. In addition, a smaller sheath precludes the use of larger catheters and equipment, which may be needed for major operations. Finally, radial artery spasm is a risk, necessitating routine use of antispasmodic medications.

Indications for radial artery sheath insertion include the following:

Absolute contraindications for radial artery sheath insertion include the following:

Relative contraindications for radial artery sheath insertion include the following:

Before attempting to insert a radial artery sheath, the operator should be familiar with the anatomy of the blood supply to the hand. The radial artery is a branch of the brachial artery, originating above the elbow. It passes down the forearm between the tendons of the brachioradialis and the flexor carpi radialis and winds around the lateral aspect of the radius. It then crosses the floor of the anatomic snuffbox to pass between the two heads of the first dorsal interosseous muscle to join the deep palmar arch.

The collateral circulation is supplied via the ulnar artery and should be assessed by performing the Allen test. This can be done either visually or with oximetry. An abnormal Allen test result is a contraindication for radial access.

Almany S, O’Neill W. Radial artery access for diagnostic and interventional procedures. Accumed Systems. Available at http://www.accumedsystemsinc.com/resources/radial_artery_access_manual.pdf. 1999; Accessed: September 27, 2018.

Zia S, Singh K, Juneja A, Schor J, Deitch J. Safety and Feasibility of Transradial Access for Noncoronary and Peripheral Vascular Interventions. Ann Vasc Surg. 2018 Jun 7. [Medline].

Tsetis DK. Arterial access. Morgan RA, Walser E. Handbook of Angioplasty and Stenting Procedures. London: Springer; 2010. 27-40.

Kiemeneij F. Prevention and management of radial artery spasm. J Invasive Cardiol. 2006 Apr. 18 (4):159-60. [Medline].

Tebaldi M, Biscaglia S, Tumscitz C, Del Franco A, Gallo F, Spitaleri G, et al. Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study. Cardiology. 2018. 140 (2):74-82. [Medline].

Kanei Y, Kwan T, Nakra NC, Liou M, Huang Y, Vales LL, et al. Transradial cardiac catheterization: a review of access site complications. Catheter Cardiovasc Interv. 2011 Nov 15. 78 (6):840-6. [Medline].

Pancholy SB, Bertrand OF, Patel T. Comparison of a priori versus provisional heparin therapy on radial artery occlusion after transradial coronary angiography and patent hemostasis (from the PHARAOH Study). Am J Cardiol. 2012 Jul 15. 110 (2):173-6. [Medline].

Pancholy SB, Ahmed I, Bertrand OF, Patel T. Frequency of radial artery occlusion after transradial access in patients receiving warfarin therapy and undergoing coronary angiography. Am J Cardiol. 2014 Jan 15. 113 (2):211-4. [Medline].

Mohsen A, Alqasrawi M, Shantha GPS, DeZorzi C, Panaich S. Comparison of Radial Artery Occlusion Following Transradial Access for Percutaneous Coronary Intervention Using Sheath-based versus Sheathless Technique. Sci Rep. 2018 Aug 13. 8 (1):12026. [Medline]. [Full Text].

Rashid M, Kwok CS, Pancholy S, Chugh S, Kedev SA, Bernat I, et al. Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2016 Jan 25. 5 (1):[Medline]. [Full Text].

Bi XL, Fu XH, Gu XS, Wang YB, Li W, Wei LY, et al. Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention. Chin Med J (Engl). 2016 Apr 20. 129 (8):898-902. [Medline]. [Full Text].

Schulte-Hermes M, Klein-Wiele O, Vorpahl M, Seyfarth M. Feasibility of Transradial Access for Coronary Interventions Via Percutaneous Angioplasty of the Radial Artery in Cases of Functional Radial Occlusion. J Invasive Cardiol. 2018 Aug 15. [Medline].

Matthew Tam, MBBCh Resident Physician, Nuclear Medicine, Royal Perth Hospital, Australia

Disclosure: Nothing to disclose.

Timothy J Roberts, MBBS, FRACP Cardiology Research Fellow, St Vincent’s Hospital Melbourne

Timothy J Roberts, MBBS, FRACP is a member of the following medical societies: Cardiac Society of Australia and New Zealand

Disclosure: Nothing to disclose.

Matthew F Erickson, MBBS, FRACP Consultant Cardiologist in Interventional Cardiology, Echo-cardiology and Advanced Heart Failure and Cardiac Transplant, Royal Perth Hospital; Consultant Cardiologist, Perth Cardiovascular Institute, Hollywood Private Hospital, Australia

Matthew F Erickson, MBBS, FRACP is a member of the following medical societies: Australian Medical Association

Disclosure: Nothing to disclose.

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors thank Catherine Tam, medical student at the Royal College of Surgeons in Ireland, for providing artwork.

Radial Artery Sheath Insertion

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