One of the major limitations to radial access is the concern for radial artery occlusion (RAO). RAO occurs in 1% to 10% of cases depending on how it is assessed. Several prior chapters have been devoted to RAO and options to prevent it. Most cases of RAO are silent and do not cause the patient harm or discomfort. However, the major issue is that it limits the ability to use the radial artery as an access site for future procedures if warranted.
There is no clear contraindication for repeated radial access provided the artery is patent and accessible. While the value of assessing dual circulation to the hand prior to radial catheterization procedures remains debatable, radial artery patency should be assessed in some manner other than physical examination in patients who are being considered for a catheterization procedure from a previously accessed radial artery. An occluded radial artery can have a strong palpable pulse due to collateralization through the palmar arch, particularly if the site of occlusion is proximal in the forearm.