Reused Radial Arterial Sheaths In Patients Undergoing Coronary Angiography: Is It Really Safe As Compared To New Sheaths?

Background
Percutaneous intervention through radial route is fast replacing the traditional femoral route but radial artery spasm, its occlusion and the pain involved are its major limitations. There is a lack of published data on safety of reused radial arterial sheaths which prompted us to evaluate its safety via a prospective, observational study.

Methods
1000 patients, undergoing radial angiography were prospectively randomized to either reused sheath group(n=493) or new sheath group (n=507). The incidence of radial artery spasm, arterial occlusion and pain scores during various time points of the procedure were recorded.

Results
The incidence of radial artery spasm was comparable in reused sheath group when compared to new sheath group (i.e. 21.9% vs. 17.95%, p=0.12). Conversely, the incidences of radial artery occlusion and catheter friction were significantly more in reused sheath group when compared with the new sheath group (i.e. 6.92% vs. 2.17% and 15.01% vs. 7.89%; both p<0.001 respectively). Significantly, more number of patients in the reused sheath group felt discomfort as defined by pain score ≥ 4 (out of a total pain score of 10), at sheath insertion, during procedure and at sheath withdrawal when compared to the same in the new sheath group [i.e. 73(14.81%) vs. 52(10.26%), p=0.03, OD=1.52, 95%CI=1.04-2.22); 77(15.62%) vs 46(9.07%), p=0.002*, OD=1.85 (95%CI =1.26-2.74) and 114(23.12%) vs 77(15.19%), p=0.002*, OD=1.68 (95%CI=1.22-2.31), respectively]. The procedural success rate was however comparable i.e. 505 (99.61%) in new versus 490 (99.39%) in reused sheath group as opposed to new sheath group (p=0.98).

Conclusions
This study demonstrated that reused sheaths although demonstrate similar rates of radial artery spasm but increased rates of radial artery occlusion and catheter friction and although comparable procedural success rates. The pain involved during the procedure was however seen to be markedly higher in the reused sheath group. These differences do not seemingly affect the success of the procedure, therefore keeping in mind the cost-benefit ratio, the reuse of sheaths in percutaneous procedures should not be discouraged, if not recommended.