Radial artery occlusion ( RAO ) is One of the most important and underdiagnosed complications of radial artery access , which is closely related to degree of Anticoagulation

1. Radial Artery Occlusion
( RAO )
By : Masoud.Sajjadi
Consultant Interventional Cardiologist at Razavi Hospital
Mashhad , Iran
July 2022

2. 1. Radial Access Complications
2. RAO Presentation
3. RAO Outcomes
4. RAO Predictors
5. RAO & Catheter size
6. RAO & Compression time
6. RAO & Anticoagulation
7. RAO Prevention
8. RAO Treatment
9. RAO Summary
Table of Contents

3. Radial Access
Complications

4. Radial Access Complications

5. RAO
Presentation

6. RAO Presentation
1. Rare ( Incidence is Variable from 1.1% to 20% )
2. Usually Asymptomatic ( Clinically Silent )
( Asymptomatic Loss of Radial Pulse due to the Extensive Collateral Circulation
from the Ulnar and Interosseous Arteries )
3. Often Reversible ( 40% to 60% of Cases, the Pulse Could be Redetected
within Hours to weeks after the Occlusion , majority will Spontaneously
Recanalize within a month )

7.  Presence of a Radial Artery Pulse Does Not Rule
Out RAO as a Result of the Presence of Collateral
Circulation Through the Palmar Arches
RAO and Radial Pulse

8. RAO
Outcomes

9. RAO Outcomes
 RAO , Even if Asymptomatic, Can :
1. Limit future Radial Access
2. Limit the Use of the Radial Artery for Dialysis Fistula
3. As a Conduit for Bypass Grafts
4. Invasive Arterial Pressure Monitoring
Though RAO Should be Prevented when Possible

10. RAO
Predictors

11. RAO Predictors
1. Small Radial Artery Diameter
2. Sheath Size ( Sheath-to-Artery Ratio) . ( 6F vs 5F )
3. Catheter size ( 6F vs 5F )
4. Repeated Procedures Using Same Access Site
5. Occlusive Hemostasis vs Patent hemostasis
6. Female Gender
7. Advanced Age
8. Low Body Weight
9. DM
10. Prolonged Compression time
11. Low-Dose or No Anticoagulation

12. RAO Predictors
1. Longer Sheath
2. Non-hydrophilic Coating
as RAO Risk Factors are Controversial

13. RAO
&
Catheter Size

14. RAO & Catheter size

15. RAO
&
Compression Time

16. RAO & Compression Time

17. RAO
&
Anticoagulation

18. RAO & Anticoagulation

19. RAO & Anticoagulation
Circulation 2017

20. RAO & Anticoagulation
JACC 2018

21. RAO & Anticoagulation
JACC 2018

22. RAO
Prevention

23. RAO Prevention
1. Smaller sheath Sizes
2. High-dose Anticoagulation ( 100 IU/kg )
3. Avoiding Repeated access of the RA
4. Utilizing Patent hemostasis After Sheath Removal
5. Shorter Compression Time
6. Additive Dose ( 500 microgram ) of Intra-Arterial
TNG before Sheath Removal

24. RAO
Treatment

25.  Treatment for Asymptomatic patients is Observation Alone
 If RAO is noted early after the Procedure (3-4 hours after removal of the TR band),
1. Ipsilateral Ulnar Artery Compression for 1 h to Promote RA Reopening has Been
shown to be Successful
2. Treatment with Anticoagulation ( Enoxaparin or Fondaparinux or NOAC )
for 4 weeks increases the rate of recanalization
RAO Treatment
( Symptomatic vs Asymptomatic )

26. RAO
Summary

27. RAO Summary
JACC 2018

28. THANKS FOR
YOUR
ATTENTION