Chapter 18: Radial Hemostasis

Radial access has gained popularity largely due to the predictable and efficient hemostasis. Radial artery compression is easy to perform because of the anatomic advantage provided by the isolation of the radial artery with no large neurovascular structures in the immediate vicinity. This attribute, paired with extensive collateralization in the forearm and the palm, and the hard surface of radius bone upon which the radial artery courses, allow for effective and frequently excessive compression of the radial artery while achieving hemostasis. This chapter will focus on the relationship between radial artery hemostasis and radial artery occlusion as well as optimizing strategies to achieve radial hemostasis while maintaining patent hemostasis.

Radial Artery Occlusion

Radial artery occlusion (RAO) is observed in 2% to 10% of patients after transradial catheterization. Extensive collateralization protects the hand from ischemic complications at rest, although occasional digital ischemia/gangrene has been reported, likely from embolization. Recanalization of the occluded radial artery occurs over the following month with re-establishment of radial artery patency in a significant fraction of patients with RAO. In patients where recanalization does not occur, permanent obliteration of radial artery lumen occurs as a result of fibrotic organization of the thrombus.

Samir B. Pancholy, MD, FACP, FACC, FSCAI; Sanjay Shah, MD, DM; Tejas M. Patel, MD, DM