Hand dysfunction after transradial artery catheterization for coronary procedures

Table 1 Study design and participant characteristics

Ref.	Study design/country/year	No. of participants	Mean age	% male	Participant inclusion criteria and procedural details
Benit et al[26]	Randomized trial; Belgium; 1994-1995	50	57.7	100%	Participants had transradial coronary angioplasty with 6-Fr catheters and Palmaz-Schatz stent
Campeau et al[27]	Cohort study; Canada; Unclear	100	58 (median)	90%	Participants had transradial coronary angiogram with 5-Fr, 6-Fr and 7-Fr sheath
Chatelain et al[28]	Cohort study; Switzerland; 1995-1997	159	60	82%	Participants had transradial diagnostic and interventional cardiac procedures with 4-Fr, 5-Fr or 6-Fr introducer sheath and guide catheters with RadiStop radial compression system
De Belder et al[29]	Cohort study; United Kingdom; Unclear	75	Unclear	69%	Participants had transradial coronary angiography and intervention and severe peripheral vascular disease with 5-Fr or 6-Fr sheath and 6-Fr guide catheter
Kiemeneij et al[30]	Cohort study; The Netherlands; 1992-1993	100	62	77%	Participants had transradial coronary angiography with 6-Fr introducer and 6-Fr-guide catheters
Lotan et al[31]	Cohort study; Israel; 1994	100	61	79%	Participants had transradial coronary angiography and angioplasty with 6-Fr introducer and 6-Fr guide catheters
Prull et al[32]	Cohort study; Germany; Unclear	93	62.5	80.6%	Participants had transradial diagnostic cardiac catheterization with 5-Fr or 6-Fr sheath or transradial coronary intervention with 7-Fr sheath
Sciahbasi et al[33]	Prospective cohort study; Italy; Unclear	99	65	72%	Participants had transradial coronary angiography and angioplasty with 6-Fr introducer sheath
Tharmaratnam et al[35]	Retrospective case control study; United Kingdom; 2005-2006	1283	65.5	79%	Participants had transradial coronary angiography and angioplasty
Valgimigli et al[39]	Prospective cohort study; The Netherlands, Italy; 2014	942	70	73%	Participants had transradial coronary angiography and angioplasty
Van Leeuwen et al[24]	Prospective cohort study; The Netherlands; 2015	286	64	72%	Participants had transradial coronary angiography and angioplasty with 6-Fr introducer sheath
Wu et al[37]	Cohort study; United States; 1996-1998	40	65	88%	Participants underwent 6-Fr and 8-Fr transradial procedure
Zankl et al[34]	Prospective cohort study; Germany; 2010	488	Unclear	Unclear	Participants had transradial coronary angiography and angioplasty with 5- and 6-Fr introducer, 4-, 5- and 6-Fr catheters

Table 2 Results of studies

Ref.	Measure of hand function and vascular complications	Follow up post procedure	Results
Benit et al[26]	Local complications assessed in clinic by history and EMG	1 mo	Nerve damage documented by EMG: 0/50 Local pain: 0/50
Campeau et al[27]	Patients were re-examined or questioned over telephone about local complications	1 to 3 mo	No nerve injury: 0/100
Chatelain et al[28]	Physicians assessed for any clinical events	Assessment prior to discharge	Paraesthesia of right thumb during exercise: 1/159
De Belder et al[29]	Clinical evaluation	4-6 wk	Haematoma and paraethesia post procedure: 1/75 Hand sensation and function at 4-6 wk: 0/75
Kiemeneij et al[30]	Examination and ultrasound study performed if radial artery pulsations or flow were absent	1 to 3 mo	Functional disability of the hand: 0/100
Lotan et al[31]	Assessment methods unclear	1 mo follow up	Small hematoma in wrist: 3/100 Small pseudoaneurysm: 2/100 Numbness of the thumb and index finger: 1/100 No flow on Doppler: 2/100
Prull et al[32]	Clinical evaluation with ultrasound	Post-procedure assessment	Vascular complication: 9/93 Motor skills, coordination or force reduction of hand after procedure: 0/93 No pseudoaneurysm: 0/93
Sciahbasi et al[33]	Radial artery occlusion by ultrasound test. Handgrip strength by Jamar Plus dynamometer. Thumb and forefinger pinch test by Jamar Plus electronic pinch gauge	Day of procedure and at least 30 d follow up	Radial artery occlusion: 9/99 Hand grip strength change at follow up: 0/99 Thumb and forefinger pinch test change at follow up: 0/99
Tharmaratnam et al[35]	Questionnaire posted to address and clinical notes for significant clinical events	Unclear	Problem with radial access site: 166/1283 (12.9%) Pain at puncture site: 95/1283 (7.4%) Swelling: 46/1283 (3.6%) Bruising: 30/1283 (2.3%) Non-specific sensory abnormalities either pain or paraesthesia in hand: 22/1283 (1.71%)
Valgimigli et al[39]	Radial artery occlusion by duplex echocardiographic examination. Hand grip strength test with dynanometer	Just after procedure, 1 d, 30 d and 1 yr	Radial artery occlusions at day 1: 5/942 Radial artery occlusions at 1 year: 3/942 Change in handgrip strength test: 0/942 Ischemic vascular or bleeding complications: 0/942
Van Leeuwen et al[24]	Quick DASH questionnaire and CISS questionnaire. Patients were asked to describe any procedure-related extremity complaints or loss of function at 1 mo	Pre, 30 d and 1 yr post procedure	Temporary upper limb complaint (< 30 d): 26/286 (9%) Persisting upper limb complaint (> 30 d): 31/286 (11%) Pain: 13/286 Numbness: 2/286 Tingling: 3/286 Stiffness: 2/286 Less power: 2/286 Upper limb function by QuickDASH at 30 d: No change over time, baseline 4.55 (IQR 0-13.64), follow up 2.27 (IQR 0-9.32) Upper limb function by CISS at 30 d: No change over time Upper limb function by QuickDASH at 1 yr: no change over time, baseline 2.39 (IQR 0-13.64), follow up 0 (0-11.02) Cold intolerance was not associated with access route at 1 yr
Wu et al[37]	Ultrasound assessment for radial artery occlusion, aneurysm or dissection. Grip strength based on dynamometer results. Palmar pinch, key pinch and tip pinch strength tests were assessed by dynamic endurance test	Late follow up 315 d	Hand complication in hospital: 0/40 Radial occlusion: 1/40 Late radial occlusions: 5/34 Radial artery aneurysm: 0/40 Radial artery dissection 0/40 Grip strength: Baseline 68 ± 34, post-catheterization 69 ± 35 Palmar pinch: Baseline 18 ± 10, post-catheterization 17 ± 6 Key pinch: Baseline 19 ± 7, post-catheterization 19 ± 6 Tip pinch: Baseline 14 ± 6, post-catheterization 14 ± 4 Endurance: Median for 6 Fr and 8 Fr is 78 (IQR 53, 108) and 58 (IQR 32, 68) respectively, post-catheterization 58 (IQR 47, 84) and 56 (IQR 38, 80), respectively
Zankl et al[34]	Assessment with ultrasound	4 wk follow up	Radial artery occlusion at 1 d: 51/488 Persistent radial artery occlusion at 4 wk: 21/488 Radial nerve paralysis: 1/488

CISS: Cold intolerance symptom severity; EMG: Electromyography.

Table 3 Summary of pooled results for hand dysfunction or vascular complications post transradial procedure

Hand dysfunction or vascular complication	No. of studies	No of events	No of participants	Percentage of events
Nerve damage	3[26,27,34]	1	638	0.16%
Sensory loss, tingling and numbness	5[24,28,29,31,35]	29	1903	1.52%
Pain	3[24,26,35]	108	1619	6.67%
Hand function, disability, grip strength change, stiffness, power loss and hand complications	6[24,30,32,33,37,39]	4	1560	0.26%
Vascular complications including occlusions, hematoma, pseudoaneurysm and dissection	6[29,31,32,35,37,39]	54	1762	3.06%
Radial artery occlusion	5[31,33,34,37,39]	40	1663	2.41%

Table 4 Disabilities of Arm, Shoulder and Hand (QuickDASH) Questionnaire

	No difficulty	Mild difficulty	Moderate difficulty	Severe difficulty	Unable
1 Open a tight or new jar	1	2	3	4	5
2 Do heavy house hold chores eg. Wash walls, floors	1	2	3	4	5
3 Carry a shopping bag or briefcase	1	2	3	4	5
4 Wash your back	1	2	3	4	5
5 Use a knife to cut food	1	2	3	4	5
6 Recreational activities in which you take some force or impact through your arm shoulder or hand	1	2	3	4	5
7 During the past week to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbors or groups?	1	2	3	4	5
8 During the past week, were you limited in your work or other daily activities as a result of your arm, shoulder or hand problem?	1	2	3	4	5
9 Arm, shoulder or hand pain	1	2	3	4	5
10 Tingling	1	2	3	4	5
11 Sleep	1	2	3	4	5

Table 5 Cold Intolerance symptoms severity Questionnaire

Questions	Score
Which of the following symptoms of cold intolerance do you experience in your injured limb on exposure to cold?
Pain, numbness, stiffness, weakness, aching, skin colour change (white/bluish white/blue)
How often do you experience these symptoms? (Please tick)
Continuously/all the time
Several times a day
Once a day
Once a week
Once a month or less
Never
When you develop cold induced symptoms, on your return to a warm environment are the symptoms relieved? (Please tick)
Not applicably
Within a few minutes
Within 30 min
After more than 30 min
What do you do to ease or prevent your symptoms occurring? (Please tick)
Take no special action
Keep hand in pocket
Wear gloves in cold weather
Wear gloves all the time
Avoid cold weather/stay indoors
Other (please specify)
How much does cold bother your injured hand in the following situations? (Please score 0-10)
Holding a glass of ice water
Holding a frozen package from the freezer
Washing in cold water
When you get out of a hot bath/shower with air room temperature
During cold wintry weather
Please state how each of the following activities have been affected as a consequence of cold induced symptoms in your injured hand and score each (please score 0-4)
Domestic chores
Hobbies and interests
Dressing and undressing
Tying your

Table 6 Boston Carpal Tunnel Syndrome Questionnaire

	1	2	3	4	5
A: Symptom severity scale (11 items)
1 How severe is the hand or wrist pain that you have at night?	Normal	Slight	Medium	Serious	Very serious
2 How often did hand or wrist pain wake you up during a typical night in the past two weeks?	Normal	Once	2-3	4-5	> 5
3 Do you typically have pain in your hand or wrist during the daytime?	No Pain	Slight	Medium	Serious	Very Serious
4 How often do you have hand or wrist pain during daytime?	Normal	1-2 times/d	1 times/d	> 5 times/d	Continued
5 How long on average does an episode of pain last during the daytime?	Normal	< 10 min	10-60 continued	> 60 min	Continued
6 Do you have numbness (loss of sensation) in your hand?	Normal	Slight	Medium	Severe	Very Serious
7 Do you have weakness in your hand or wrist?	Normal	Slight	Medium	Severe	Very Serious
8 Do you have tingling sensations in your hand?	Normal	Slight	Medium	Severe	Very Serious
9 How severe is numbness (loss of sensation) or tingling at night?	Normal	Slight	Medium	Severe	Very Serious
10 How often did hand numbness or tingling wake you up during a typical night during the past two weeks?	Normal	Once	2-3 times	4-5 times	> 5
11 Do you have difficulty with the grasping and use of small objects such as keys or pens?	Without difficulty	Little difficulty	Moderate difficulty	Very difficulty	Very difficult
B: Functional status scale (8 items)
Writing
Buttoning of cloths
Holding a book while reading
Gripping of a telephone handle
Opening of jars
House hold chores
Carrying of grocery basket
Bathing and dressing