Chapter 6: Contraindications to Radial Artery Access

The radial artery is considered a superior access site for percutaneous coronary and peripheral interventions due to its easy compressibility, low bleeding complication rate, and association with reduced mortality in high-risk patient populations.

Although it is the primary approach in some laboratories, there are some contraindications to obtaining radial access (Figure 1). The brevity of the list of contraindications (Table 1) reflects the versatility of the radial approach. This list may serve as a reference, particularly for less experienced radial operators. More experienced radial operators may feel comfortable attempting access in more complicated situations.

Absence of Radial Pulse or Abnormal Allen’s Test

The absence of a palpable radial pulse, evidence of hand ischemia, or presence of infection or a full thickness burn should prompt consideration for alternative access. The radial artery pulse should be palpated and documented in every patient when radial access is considered. The hand and digits should be inspected for presence of discoloration, ulcerations, and gangrene.

Alice A. Perlowski, MD, FACC, FSCAI and Morton Kern, MD, FACC, MSCAI, FAHA