The Relationship between Amount of Air Supplied to Radial Artery Compression Device Used after Transradial Procedure and Radial Artery Stenosis.

Background: Transradial access (TRA) is accepted as the safest route for coronary angiography (CAG) and percutaneous coronary intervention. Radial artery stenosis (RAS) prevents use of the radial artery in various clinical situations, even in cases without hand ischemia. In this context, this study aimed to investigate the relationship between the amount of air supplied to the radial artery compression device [transradial (TR) band] and RAS. Methods: The population in this single-center retrospective study consisted of patients who underwent CAG via TRA under elective conditions between March 1st, 2020 and May 1st, 2022. Of these patients, 111 who met the study inclusion criteria were included in the study. Results: The rate of RAS was significantly higher among the patients with a TR band inflated with 18 ml of air compared to those with a TR band inflated with 12 ml of air (19.6%-3.6%; p = 0.009). Univariable logistic regression analysis revealed that the mean corpuscular volume (MCV) and amount of air supplied to the TR band were significantly associated with RAS. Further analysis of these variables with multivariable logistic regression analysis indicated that both MCV and the amount of air supplied to the TR band were independent predictors of RAS (p < 0.05). Conclusions: The findings of the study revealed that the amount of air supplied to the TR band after CAG via TRA was an independent predictor for the development of RAS.

Radial artery pseudoaneurysm: a simplified treatment method.

A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery.

Successful Treatment of Radial Artery Pseudoaneurysm After Transradial Cardiac Catheterization With Continuous Compression Therapy by a TR Band® Radial Compression Device.

Arterial pseudoaneurysm formation after transradial cardiac catheterization is a rare post-procedural complication occurring in less than 0.1% of radial arterial access. While the data on the management of femoral pseudoaneurysms is extensive, few studies have evaluated how these techniques apply for small vessel arterial pseudoaneurysms. We present the case of an octogenarian man with a radial artery pseudoaneurysm after transradial coronary intervention that failed initial compression therapy, and surgical intervention was avoided by applying continuous compression therapy with a TR Band® radial compression device.

Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route.

AIM: Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. METHODS: All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale. RESULTS: A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 (n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 (n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 (p = 0.01). CONCLUSION: A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.

Expedited TR Band Removal for Transradial Approach for Noncoronary Visceral Procedures: Initial Experience.

PURPOSE: For transradial interventions, most published studies report an initial Terumo Radial (TR) band placement time of 60 minutes, with gradual deflation over 30 to 90 minutes. We aimed to determine, retrospectively, whether TR band removal time could be expedited to 45 to 60 minutes, without adverse effects via an expedited single-step deflation protocol. METHODS: A total of 115 consecutive noncoronary visceral interventions that utilized TR band from September 2017 till February 2019 were retrospectively reviewed. Alternative single-step deflation protocol was utilized where the nursing staff was instructed to deflate the TR band in 1 step between 45 and 60 minutes; 79 patients (43 men, 36 women, mean age of 55.3 ± 13.6 years) underwent 115 transradial interventions. Mean procedure time was 49.8 ± 22.1 minutes, and mean fluoroscopy time was 18.5 ± 10.6 minutes. Data collected included patient demographics, procedure details, and nursing notes on complications including bleeding and reinflation of the TR band. Univariate and Multivariate analyses of independent variables were performed using a binary logistic regression model. All patients were followed up postoperatively before discharge and in clinic upon follow-up. RESULTS: The TR band was deflated at 51.3 ± 14.5 minutes, with successful removal achieved on the first attempt in 103 cases (90.3% primary technical success rate). In 12 cases, bleeding was noted upon initial deflation, secondary technical success was achieved when the band was reinflated for an additional mean time of 37.0 ± 19.1 minutes. There was 1 incidence of radial artery occlusion (0.8%) and 1 incidence of a grade 1 hematoma (0.8%). The only variable predictive of technical outcome upon initial band deflation on univariate binomial logistic regression was initial TR band removal time (P = .019). CONCLUSIONS: A single-step deflation protocol for TR band placement may be safe for nonocclusive patent hemostasis and may translate to even further shorten postprocedural hospital times for patients and cost savings for hospitals.

Comparison of Hemostasis Times with a Chitosan-Based Hemostatic Pad (Clo-SurPlus Radial™) vs Mechanical Compression (TR Band®) Following Transradial Access: A pilot Study.

BACKGROUND: Hemostasis following transradial arterial access (TRA) is usually achieved by mechanical compression. This study investigated if use of a chitosan-based hemostatic pad (Clo-SurPlus Radial™) combined with mechanical compression (TR Band®) could shorten hemostasis time after TRA, compared with a TR Band® alone. METHODS: 40 patients undergoing cardiac catheterization and/or percutaneous coronary intervention were assigned into 4 cohorts post TRA: 10 patients received mechanical compression with a TR Band® alone for 120 min. The other 30 patients received compression with a Clo-SurPlus Radial™ pad combined with a TR Band® for 60 min, 45 min, and 30 min, respectively (n = 10/per cohort). Times to hemostasis and access-site complications were recorded. RESULTS: There were no differences in patient characteristics, mean dose of heparin, or mean activated clotting time value at the end of procedure among the four cohorts. Median time to hemostasis with the TR Band® alone was 120.5 min versus 60 min, 45 min and 30 min for the 60-min, 45-min, and 30-min Clo-SurPlus Radial™ pad combined with the TR Band® cohorts, respectively. No radial artery occlusion, late rebleeding nor hematoma was noted in this series of patients. CONCLUSIONS: In this pilot trial, use of a Clo-SurPlus Radial™ pad in combination with a TR band® significantly shortened hemostasis time, as compared to a TR band® alone, with no increased complications noted.