Transradial Angiography and Intervention

Publication Date: December 27, 2019
Last Updated: March 14, 2022

Recommendations

ULTRASOUND GUIDANCE FOR ARTERIAL ACCESS

  1. Operators should develop proficiency with ultrasound guidance to facilitate forearm vascular access.
  2. Real-time ultrasound guidance should be available and used when difficulty with radial access is encountered or expected.
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ULNAR ARTERY ACCESS

  1. Radial artery access is preferred over ulnar artery access in most situations.
  2. The ulnar artery may be a reasonable alternate access site when the risks of radial access failure or complication are high (e.g., small radial diameter, calcification, tortuosity, or anatomic anomaly).
  3. The ipsilateral ulnar artery may be a reasonable secondary access site after failed radial access; however, the data are limited.
  4. In cases of radial artery occlusion, there are insufficient data to provide a recommendation on the use of the ipsilateral ulnar artery over alternate access sites such as the contralateral radial or femoral arteries.
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UTILITY OF NONINVASIVE ASSESSMENT OF COLLATERAL FLOW OR PALMAR ARCH PATENCY

  1. Transradial catheterization can be performed regardless of results of noninvasive collateral testing. Routine collateral testing should not be used as a triage tool for access site selection.
  2. Collateral testing may be useful in screening for postprocedural radial artery occlusion and in assessing the adequacy of hemostasis techniques.
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PREVENTION OF RADIAL ARTERY OCCLUSION: OVERVIEW OF CURRENT PRACTICES

Updated or new recommendations

  1. Administration of intravenous or intra-arterial unfractionated heparin 5,000 U or 50 U/kg or a higher dose as a bolus is recommended following placement of radial artery introducer sheath.
  2. Concomitant ipsilateral ulnar artery compression is recommended to further maximize radial artery patency.
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Continued recommendations

  1. Use of lowest profile sheath and/or catheter system required for procedural success, with attention to sheath/catheter-to-artery ratio.
  2. Patent hemostasis should be the default strategy, regardless of the method or device used for compression of the arteriotomy.
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RADIAL ACCESS FOR PRIMARY PCI FOR STEMI

  1. Transradial access (TRA) can be used for primary PCI to reduce vascular complications and bleeding in cardiac catheterization laboratories with appropriate training and expertise in radial access procedures.
  2. Operators should become experienced with nonemergent TRA PCI prior to performing STEMI TRA PCI.
  3. Appropriately defined strategies for arterial access site crossover (contralateral radial or femoral) should be in place to facilitate the decision process during emergencies in order to avoid delays in revascularization and ensure optimal outcomes.
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Recommendation Grading

Overview

Title

Transradial Angiography and Intervention

Authoring Organization

Society for Cardiovascular Angiography and Interventions

Publication Month/Year

December 27, 2019

Last Updated Month/Year

July 5, 2023

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

The use of ultrasound to facilitate radial access, the role of ulnar artery access, the utility of non‐invasive testing of collateral flow, strategies to prevent radial artery occlusion, radial access for primary PCI and topics that require further study.

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D062645 - Percutaneous Coronary Intervention, D003324 - Coronary Artery Disease, D006328 - Cardiac Catheterization

Keywords

angiogram, cardiac catheterization, cardiac catheterization laboratory, angiography

Source Citation

Shroff, AR,  Gulati, R,  Drachman, DE, et al.  SCAI expert consensus statement update on best practices for transradial angiography and intervention. Catheter Cardiovasc Interv.  2020; 95: 245– 252. https://doi.org/10.1002/ccd.28672

Supplemental Methodology Resources

Methodology Supplement, Project Plan