The effect of pre-procedure sublingual nitroglycerin on radial artery diameter and Allen's test outcome - Relevance to transradial catheterization |
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| Affiliation: | 1. University of Ottawa Heart Institute, Canada;2. Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom;3. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom;1. Microbiology Research Laboratory on Environmental Health (EnviHealthMicroLab), Faculty of Medicine, Institute of Environmental Health (ISAMB), University of Lisbon, 1649-028 Lisbon, Portugal;2. Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal;3. Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal;4. Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;5. Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal;6. Rheumatology Department, University Hospital Center of São João (CHUSJ), Porto, Portugal;7. Healthcare Management Department, Hospital Quirón Salud San José, 28002 Madrid, Spain;8. Allergy Unit, CUF Institute and Hospital, 4460-188 Porto, Portugal;9. Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain;10. Service of Pneumology, University Hospital of Moncloa, 28008 Madrid, Spain;11. Hospital Clinic of Barcelona, 08036 Barcelona, Spain;12. Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain;13. REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain;14. Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal |
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| Abstract: | BackgroundThe radial artery is increasingly used for cardiac procedures, but is a relatively small vessel that is prone to spasm when instrumented. Intra-arterial nitroglycerine has been shown to reduce radial spasm but first requires arterial access. We investigated the effect of pre-procedure sublingual nitroglycerin (NTG) on the diameter of the radial artery in a large cohort of patients.Methods305 subjects underwent ultrasound measurement of their radial and ulnar arteries in both arms before and after the administration of 800 μg of sublingual NTG. The Allen's test was also performed in the subjects prior to and after NTG.ResultsRadial artery diameter in this Caucasian study group is larger than that reported for other populations. The administration of sublingual NTG significantly increased the size of the right radial artery from 2.88 ± 0.36 mm to 3.36 ± 0.40 mm in men and from 2.23 ± 0.37 up to 2.74 ± 0.36 mm in women. There were also significant increases in left radial, right and left ulnar artery diameters in males and females with NTG. There was no significant effect of NTG on blood pressure. In all patients with an unfavourable Allen's test, retesting following sublingual NTG resulted in transition to a favourable Allen's.ConclusionCaucasian populations have larger calibre radial arteries compared to other geographic areas. Sublingual NTG is effective at dilating the radial artery in both men and women. This may make radial artery puncture and cannulation less challenging and should be considered in all patients in the absence of contraindications. The results of Allen's testing are dynamic and its usefulness for screening prior to transradial access is undetermined. |
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