INTERACTION OF SHEATH-to-RADIAL ARTERY DIAMETER RATIO AND HEMOSTASIS DURATION INCREASED THE RISK OF RADIAL ARTERY OCCLUSION BY 11-FOLD AFTER TRANSRADIAL CATHETERIZATION

Background
The interaction of sheath to radial artery diameter ratio (S/RAD) ratio and hemostasis duration with radial artery occlusion (RAO) after transradial procedure has not been explored. We investigated the interaction effect of S/RAD ratio and hemostasis duration with the risk of RAO in a large series of patients who underwent transradial catheterization

Methods
We performed a retrospective analysis of a database consist of 1706 patients who underwent trans-radial catheterization at three radial centers during three months period. The S/RAD ratio was calculated by dividing the outer sheath diameter (mm) with inner diameter of the radial artery (mm). RAO was diagnosed by Doppler ultrasound of the accessed arteries at the day after the procedure. Multivariate logistic regression was used to find the interaction p-values.

Results
The median radial artery diameter was 2.8 mm (25th percentile to 75th percentile: 2.5-3.0 mm) and mean S/RAD ratio was 0.73 ± 0.14. Hemostasis compression >4h [odds ratio (OR) = 5.12, p< 0.001] and S/RAD ratio >1 (OR= 3.16, p< 0.001) are each associated with RAO. The interaction of S/RAD ratio >1 and hemostasis compression >4h markedly increased the risk of RAO (adjusted OR= 11.01; 95% confidence interval, 3.6-33.6, p< 0.001).

Conclusions
In this study, the interaction of S/RAD ratio and duration of hemostasis increased the risk of RAO by 11-fold in patients who underwent transradial catheterization. The result suggests an important opportunity to reduce RAO after transradial catheterization by probably evaluating the radial artery diameter of the patient by Doppler ultrasound before the transradial procedure for the selection of both radial sheath size and hemostasis protocol.