RADIAL ARTERY ACCESS FOR CORONARY INTERVENTION IN ELDERLY PATIENTS: COMPLICATIONS AND RISK REDUCTION STRATEGIES

Nguyễn Trung Hiếu 1 , Phan Kiều Hưng 1 , , Ngô Văn Hào 1 , Vũ Thi Lan Anh 1 , Nguyễn Thị Thu Hiền 1 , Nguyễn Hoàng Long 1 , Đinh Minh Hoàng 1 , Nguyễn Đức Hiếu 1
1 Tam Anh General Hospital, Ha Noi image/svg+xml
* Corresponding author:

Article Information

Metrics
Downloads: 0 Views: 0
DOI
10.63947/bvtn.v2i8.7
Published
2026-06-07
Issue Vol. 2 No. 8 (2026): Geriatric Medicine in the Era of Personalization, Technology, and Prevention
Section
Review Article
Categories
Research

Download Article

PDF (Vietnamese)

How to Cite

1.
Trung Hiếu N, Kiều Hưng P, Văn Hào N, Thi Lan Anh V, Thị Thu Hiền N, Hoàng Long N, Minh Hoàng Đinh, Đức Hiếu N. RADIAL ARTERY ACCESS FOR CORONARY INTERVENTION IN ELDERLY PATIENTS: COMPLICATIONS AND RISK REDUCTION STRATEGIES. JHA [Internet]. Vietnam; 2026 Jun. 7 [cited 2026 Jun. 18];2(8):48–58. https://tcsuckhoelaohoa.vn/bvtn/article/view/211 doi: 10.63947/bvtn.v2i8.7
Loading citation...
Crossref
Scopus
Google Scholar
Europe PMC

Abstract

The number of elderly patients undergoing coronary angiography and percutaneous coronary intervention is steadily increasing, creating an urgent need for effective management of vascular access complications, particularly important in geriatric patients with multiple specific risk factors. Although radial artery access is superior to femoral access in terms of bleeding and mortality, elderly patients remain at higher risk due to specific anatomical and physiological changes: arterial tortuosity, calcification, small luminal diameter, and reduced elasticity; coupled with frailty, multimorbidity, polypharmacy, impaired renal function, and coagulation disorders. This narrative review analyzes the incidence, pathophysiology, and risk reduction strategies for radial artery access complications in the elderly, including individualized approaches: geriatric risk assessment, ultrasound-guided puncture, slender sheaths, patent hemostasis techniques, distal radial access considerations, and optimized anticoagulation–antiplatelet therapy. Evidence from randomized trials, meta-analyses, and real-world data is synthesized, alongside an assessment of the current state and research gaps in Vietnam.

Keywords

coronary angiography percutaneous coronary intervention complications vascular access elderly

References

  1. Damluji AA, Resar JR, Gerstenblith G, Gross AL, Forman DE, Moscucci M. Temporal Trends of Per- cutaneous Coronary Interventions in Older Adults With Acute Myocardial Infarction: An Increasing Rate of Utilization in Very Old Adults. Circ: Cardiovascular Interventions. 2019 May;12(5):e007812. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.119.007812
  2. Shanmugam VB, Harper R, Meredith I, Malaiapan Y, Psaltis PJ. An overview of PCI in the very elderly. Journal of Geriatric Cardiology. 2015;12:174−184. doi:10.11909/j.issn.1671-5411.2015.02.012
  3. Fazel R, Rao SV, Cohen DJ, Secemsky E, Swaminathan RV, Manandhar P, Rymer JA, Wojdyla D, Yeh RW. LB-1 | Temporal Trends and Clinical Outcomes with Radial Versus Femoral Arterial Access for Percutaneous Coronary Intervention in the United States. Journal of the Society for Cardiovascular Angiography & Interventions. 2024 May;3(5):101866. doi:10.1016/j.jscai.2024.101866 DOI: https://doi.org/10.1016/j.jscai.2024.101866
  4. Numasawa Y, Inohara T, Ishii H, Yamaji K, Kohsaka S, Sawano M, Kodaira M, Uemura S, Kadota K, Amano T, Nakamura M, on behalf of the J‐PCI Registry Investigators, Kadota K, Shiode N, Tanaka N, Amano T, Uemura S, Akasaka T, Morino Y, Fujii K, Hikichi H, Kohsaka S, Ishii H, Tanabe K, Ozaki Y, Sumitsuji S, Iida O, Hara H, Takashima H, Shirai S, Nanasato M, Inohara T, Ueda Y, Numasawa Y, Noma S. Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J‐PCI Registry). JAHA. 2019 Mar 5;8(5):e011183. doi:10.1161/JAHA.118.011017 DOI: https://doi.org/10.1161/JAHA.118.011017
  5. Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El-Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Heart Group, editor. Cochrane Database of Systematic Reviews. 2018 Apr 18;2018(4). doi:10.1002/14651858.CD012318.pub2 DOI: https://doi.org/10.1002/14651858.CD012318.pub2
  6. Sandoval Y, Bell MR, Gulati R. Transradial Artery Access Complications. Circ: Cardiovascula Interventions. 2019 Nov;12(11):e007386. doi:10.1161/CIRCINTERVENTIONS.119.007386 DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.119.007386
  7. Nguyen TV, Le D, Tran KD, Bui KX, Nguyen TN. Frailty in Older Patients with Acute Coronary Syndrome in Vietnam. CIA. 2019 Dec;Volume 14:2213–22. doi:10.2147/CIA.S234597 DOI: https://doi.org/10.2147/CIA.S234597
  8. Aoun J, Hattar L, Dgayli K, Wong G, Bhat T. Update on complications and their management during transradial cardiac catheterization. Expert Review of Cardiovascular Therapy. 2019 Oct 3;17(10):741–51. doi:10.1080/14779072.2019.1675510 DOI: https://doi.org/10.1080/14779072.2019.1675510
  9. Nakata T, Ikeda S, Koga S, Yoshida T, Koide Y, Kawano H, Maemura K, Kohno S. Impact of Catheter Sheath Insertion into the Radial Artery on Vascular Endothelial Function Assessed by Reactive Hyperemia Peripheral Arterial Tonometry. Int Heart J. 2015;56(5):489–94. doi:10.1536/ihj.15-094 DOI: https://doi.org/10.1536/ihj.15-094
  10. Yu Q, Guo D, Peng J, Wu Q, Yao Y, Ding M, Wang J. Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta‐analysis. Clinical Cardiology. 2023 Jan;46(1):5–12. doi:10.1002/ DOI: https://doi.org/10.1002/clc.23929
  11. clc.23929
  12. Rashid M, Kwok CS, Pancholy S, Chugh S, Kedev SA, Bernat I, Ratib K, Large A, Fraser D, Nolan J, Mamas MA. Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta‐Analysis. JAHA. 2016 Jan 13;5(1):e002686. doi:10.1161/JAHA.115.002686 DOI: https://doi.org/10.1161/JAHA.115.002686
  13. Tsigkas G, Papanikolaou A, Apostolos A, Kramvis A, Timpilis F, Latta A, Papafaklis MI, Aminian A, Davlouros P. Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations. JCDD. 2023 Jun 30;10(7):283. doi:10.3390/jcdd10070283 DOI: https://doi.org/10.3390/jcdd10070283
  14. Didagelos M, Pagiantza A, Papazoglou AS, Moysidis DV, Petroglou D, Daios S, Anastasiou V, Theodoropoulos KC, Kouparanis A, Zegkos T, Kamperidis V, Kassimis G, Ziakas A. Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization. JCM. 2024 Jun 1;13(11):3276. doi:10.3390/jcm13113276 DOI: https://doi.org/10.3390/jcm13113276
  15. Zus AS, Crișan S, Luca S, Nișulescu D, Valcovici M, Pătru O, Lazăr MA, Văcărescu C, Gaiță D, Luca CT. Radial Artery Spasm—A Review on Incidence, Prevention and Treatment. Diagnostics. 2024 Aug 29;14(17):1897. doi:10.3390/diagnostics14171897 DOI: https://doi.org/10.3390/diagnostics14171897
  16. Collins N, Wainstein R, Ward M, Bhagwandeen R, Dzavik V. Pseudoaneurysm after transradial cardiac catheterization: Case series and review of the literature. Cathet Cardiovasc Intervent. 2012 Aug 1;80(2):283–7. doi:10.1002/ccd.23216 DOI: https://doi.org/10.1002/ccd.23216
  17. Lavi S, Cheema A, Yadegari A, Israeli Z, Levi Y, Wall S, Alemayehu M, Parviz Y, Murariu B, McPherson T, Syed J, Bagur R. Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention. JAHA. 2017 Feb 2;6(2):e005029. doi:10.1161/JAHA.116.005029 DOI: https://doi.org/10.1161/JAHA.116.005029
  18. Shroff A, Siddiqui S, Burg A, Singla I. Identification and Management of Complications of Transradial Procedures. Curr Cardiol Rep. 2013 Apr;15(4):350. doi:10.1007/s11886-013-0350-x DOI: https://doi.org/10.1007/s11886-013-0350-x
  19. Yoo BS, Yoon J, Ko JY, Kim JY, Lee SH, Hwang SO, Choe KH. Anatomical consideration of vessel tortuosity. International Journal of Cardiology. 2005 Jun;101(3):421–7. doi:10.1016/j.ij- card.2004.03.061 DOI: https://doi.org/10.1016/j.ijcard.2004.03.061
  20. Harvey JA, Kim S, Ireson ME, Gulati R, Bell MR, Moran SL. Acute Upper-Limb Complications Following Radial Artery Catheterization for Coronary Angiography. The Journal of Hand Surgery. 2020 Jul;45(7):655.e1-655.e5. doi:10.1016/j.jhsa.2019.11.007 DOI: https://doi.org/10.1016/j.jhsa.2019.11.007
  21. Wang SS, Liu WH. Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis. World J Clin Cases. 2024 Jan 6;12(1):107–18. doi:10.12998/wjcc.v12.i1.107 DOI: https://doi.org/10.12998/wjcc.v12.i1.107
  22. Kumar S, Kearney KE, Chung CJ, Elison D, Steinberg ZL, Lombardi WL, McCabe JM, Azzalini L. Frailty and Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention. Cathet Cardio Intervent. 2025 Dec;106(7):3409–18. doi:10.1002/ccd.70219 DOI: https://doi.org/10.1002/ccd.70219
  23. Safirstein JG, Tehrani DM, Schussler JM, Reid N, Mukerjee K, Weber L, Liu H, Skenderian S, Simeon M, Yang T, Seto AH. Radial Hemostasis Is Facilitated With a Potassium Ferrate Hemostatic Patch. JACC: Cardiovascular Interventions. 2022 Apr;15(8):810–9. doi:10.1016/j.jcin.2021.12.030 DOI: https://doi.org/10.1016/j.jcin.2021.12.030
  24. Oliveira MD, Navarro E, Branca N, Garcia M, Scarpa M, Caixeta A. Coronary Procedures via Distal Transradial Access in Older as Compared With Non-Older Patients: Insights From the DIS- TRACTION Registry. J Invasive Cardiol. 2023;35(9). doi:10.25270/jic/23.00132 DOI: https://doi.org/10.25270/jic/23.00132
  25. Roh JW, Kim Y, Lee OH, Im E, Cho DK, Choi D, Jeong MH. The learning curve of the distal radial access for coronary intervention. Sci Rep. 2021 Jun 24;11(1):13217. doi:10.1038/s41598021-92742-7 DOI: https://doi.org/10.1038/s41598-021-92742-7
  26. Wang H, Wang HY, Wu SY, Yin D, Feng L, Song WH, Wang HJ, Zhu CG, Dou KF. Effect of Thin-Walled Radial Sheath for Large-Bore Access On Reducing Periprocedural Radial Artery Occlu- sion Following Complex PCI: The REDUCE-RAO Randomized Trial. Rev Cardiovasc Med. 2022 Sep 28;23(10):329. doi:10.31083/j.rcm2310329 DOI: https://doi.org/10.31083/j.rcm2310329
  27. Aminian A, Dolatabadi D, Lefebvre P, Zimmerman R, Brunner P, Michalakis G, Lalmand J. Initial experience with the glidesheath slender for transradial coronary angiography and intervention: A feasibility study with prospective radial ultrasound follow‐up. Cathet Cardio Intervent. 2014 Sep;84(3):436–42. doi:10.1002/ccd.25232 DOI: https://doi.org/10.1002/ccd.25232
  28. Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, Perry RA, Morris JL. randomized comparison of TR band and radistop hemostatic compression devices after transradial coronary intervention. Cathet Cardiovasc Intervent. 2010 Nov 1;76(5):660–7. doi:10.1002/ccd.22615 DOI: https://doi.org/10.1002/ccd.22615
  29. Anchan R, Venturini J, Larsen P, Lee L, Fernandez C, Besser SA, Kalathiya R, Paul J, Blair J, Nathan S. Safe and rapid radial hemostasis achieved using a novel topical hemostatic patch: Results of a first‐in‐human pilot study using hydrophobically modified polysaccharide‐chitosan. Cathet
  30. Cardio Intervent. 2022 Feb;99(3):786–94. doi:10.1002/ccd.29529 DOI: https://doi.org/10.1002/ccd.29529
  31. Mlekusch W, Minar E, Dick P, Sabeti S, Bartok A, Haumer M, Bonelli M, Vormittag L, Koppensteiner R, Schillinger M. Access Site Management after Peripheral Percutaneous Transluminal Procedures: Neptune Pad Compared with Conventional Manual Compression. Radiology. 2008 Dec;249(3):1058–63. doi:10.1148/radiol.2492080181 DOI: https://doi.org/10.1148/radiol.2492080181
  32. Kang SH, Han D, Kim S, Yoon CH, Park JJ, Suh JW, Cho YS, Youn TJ, Chae IH. Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial. De Rosa S, editor. PLoS ONE. 2017 Jul 24;12(7):e0181099. doi:10.1371/journal.pone.0181099 DOI: https://doi.org/10.1371/journal.pone.0181099
  33. Vu HTT, Norman R, Pham NM, Pham HM, Nguyen HTT, Nguyen QN, Do LD, Huxley RR, Lee CMY, Hoang TM, Reid CM. Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes. The Lancet Regional Health - Western Pacific. 2021 Apr;9:100116. doi:10.1016/j.lanwpc.2021.100116 DOI: https://doi.org/10.1016/j.lanwpc.2021.100116
  34. Nguyễn TL, Vũ NT, Bùi TD, Bùi ĐN, Nguyễn HK, Nguyễn VĐ. KẾT QUẢ BĂNG ÉP VỊ TRÍ CHỌC ĐỘNG MẠCH TRONG PHÒNG THÔNG TIM CAN THIỆP TẠI BỆNH VIỆN ĐẠI HỌC Y HÀ NỘI. VMJ. 2025 Jan 28;546(2). doi:10.51298/vmj.v546i2.12596 DOI: https://doi.org/10.51298/vmj.v546i2.12596
  35. Phan Kiều Hưng, Ngô Văn Hào, Nguyễn Trung Hiếu. Đặc điểm băng ép cơ học thông thường và băng ép sử dụng miếng cầm máu ở bệnh nhân sau chụp hoặc can thiệp động mạch vành qua da tại Bệnh viện Đa khoa Tâm Anh Hà Nội. Tạp chí Tim mạch học Việt Nam. 2025;117:158–65. doi:10.58354/jvc.117.2025.954 DOI: https://doi.org/10.51298/vmj.v558i2.17077
  36. Thu NTH, Lý NTM, Quân TH, Nhơn BV, Ánh HT, Thép ĐÁ, Hạnh TV. Tỷ lệ biến chứng vết thương chọc mạch sau chụp và can thiệp động mạch vành và các yếu tố liên quan tại Bệnh viện Đại học Y Hà Nội. tcncyh. 2021 May 12;138(2):124–39. doi:10.52852/tcncyh.v138i2.83 DOI: https://doi.org/10.52852/tcncyh.v138i2.83
  37. Võ TN, Nguyễn MC, Nguyễn VD, Trần HN, Đỗ TÚT, Nguyễn MT, Phạm ND, Phạm ND. TÍNH KHẢ THI CỦA CÁCH TIẾP CẬN QUA ĐOẠN XA ĐỘNG MẠCH QUAY TRÁI TRONG CHỤP VÀ CAN THIỆP MẠCH VÀNH. VMJ. 2023 Mar 24;524(1B). doi:10.51298/vmj.v524i1B.4799 DOI: https://doi.org/10.51298/vmj.v524i1B.4799
  38. Nguyễn VN, Phạm TP, Ngô HT, Trần KS. NGHIÊN CỨU KẾT QUẢ CAN THIỆP ĐỘNG MẠCH VÀNH QUA DA BẰNG ĐƯỜNG VÀO ĐOẠN XA ĐỘNG MẠCH QUAY Ở BỆNH NHÂN HỘI CHỨNG ĐỘNG MẠCH VÀNH MẠN TẠI BỆNH VIỆN ĐA KHOA TRUNG ƯƠNG CẦN THƠ. VMJ. 2024 Jun 18;539(1B). doi:10.51298/vmj.v539i1B.9936 DOI: https://doi.org/10.51298/vmj.v539i1B.9936

License

© 2026 The Author(s). Published by Journal of Health and Aging.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.