Abstract 17406: Early Experience With Ultrasound Guided Distal Trans-Radial Access in the Anatomical Snuffbox in Coronary Angiography and Intervention

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Sangyeub Lee ◽  
Woong-su Yoon ◽  
Daehwan Bae ◽  
Min Kim ◽  
Sang Min Kim ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Success Rate ◽  
Radial Artery ◽  
Early Experience ◽  
Coronary Intervention ◽  
Ultra Sound ◽  
Potential Candidate ◽  
Ultrasound Guided ◽  
Radial Approach ◽  
Radial Access

Early experience with ultrasound guided distal trans-radial access in the anatomical snuffbox in coronary angiography and intervention. Objective: We aimed to demonstrate the feasibility and safety of the ultrasound guided distal trans-radial coronary angiography and intervention. Methods: Patients assigned to one operator program underwent diagnostic or procedural intervention through distal trans-radial approach in the anatomical snuffbox between January 2018 and May 2018. All of patients had palpable artery in their distal radial artery. The operator did the coronary procedure via distal radial access at anatomical snuffbox. When the pulse was weak or the target artery was very small, the operator punctured under ultrasound guidance (V-scan with dual probe, GE heathcare, USA) Results: 56 patients were enrolled. Mean age of patients was 65.1 years old and 68% were male. About 70% of patients were presented with stable angina feature. In diagnostic procedure, 4F (3, 5.6%) or 5F (29, 54.7%) sheath was used and we did coronary intervention via 6F (21, 39.6%) Sheath. Ultrasound guided puncture was done for 33 patients (58.9%). Overall Success rate of distal trans-radial angiography and intervention was 94.6% (3 failed cases). Success rate of ultrasound guided procedure was 97% (only 1 failed case). Left distal radial puncture was done for 18 patients (33.9%). 16% of patients had chronic kidney disease, especially end stage renal disease (11%) to preserve radial artery which was potential candidate of arteriovenous fistulae for dialysis. There was no BARC type 2-5 bleeding in hospital stay and follow up at out-patient clinic. Conclusion: Ultra sound guided distal radial approach is feasible and safe as a good alternative technique for coronary angiography and interventions.

P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Ognerubov ◽  
A Tereshchenko ◽  
E Merkulov ◽  
S Provatorov ◽  
G Arutyunyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Stable Coronary Artery Disease ◽  
Ulnar Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Careful Examination ◽  
Radial Access ◽  
Short Time

Abstract Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions. Aim To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access. Materials and methods During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO. Results The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P<0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01). Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 <0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 <0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01 Conclusion Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.

scholarly journals Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience

2021 ◽  
Vol 10 (24) ◽  
pp. 5974
Author(s):  
Alexandru Achim ◽  
Kornél Kákonyi ◽  
Zoltán Jambrik ◽  
Ferenc Nagy ◽  
Julia Tóth ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Success Rate ◽  
Radial Artery ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Learning Curves ◽  
Bleeding Complications ◽  
Entry Site ◽  
Catheterization Laboratory ◽  
Distal Radial Artery

Introduction: Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. Methods: The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed. Results: The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access. Conclusion: The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.

scholarly journals Feasibility of Ultrasound-Guided Transoccluded Radial Access for Coronary Angiography or Percutaneous Coronary Intervention

2020 ◽  
Vol 13 (17) ◽  
pp. 2088-2090 ◽  
Author(s):  
Shinsuke Mori ◽  
Keisuke Hirano ◽  
Kenji Makino ◽  
Yohsuke Honda ◽  
Masakazu Tsutsumi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Ultrasound Guided ◽  
Radial Access ◽  
Percutaneous Coronary

scholarly journals Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Mohammad Shafiq ◽  
Hesham Boushra Mahmoud ◽  
Malak Lamie Fanous
Keyword(s):  
Coronary Angiography ◽  
Radial Artery ◽  
Ulnar Artery ◽  
Coronary Intervention ◽  
Radial Approach ◽  
Percutaneous Coronary ◽  
Procedural Time ◽  
Coronary Procedures ◽  
Doppler Evaluation ◽  
The Right

Abstract Background Trans-ulnar approach was proposed primarily for elective procedures in patients not suitable for trans-radial approach that was introduced two decades ago. The trans-ulnar approach is as safe and effective as the trans-radial approach for coronary angiography and intervention. Aim This study’s aim was to assess the feasibility and safety of the trans-ulnar approach in coronary procedures as a preliminary experience for operators experienced in trans-radial approach with no/minimal trans-ulnar approach experience at an Egyptian center. Results Vascular access in 120 patients was selected randomly for coronary angiography and angioplasty—80 through radial and 40 through ulnar approach. Patients were examined for local complications and Doppler evaluation to both radial and ulnar arteries a day after the procedure was done. Ulnar approach success was 82.5% versus 93.7% in the radial group; failure of ulnar artery puncture was the only cause of crossover in the ulnar group, while occurrence of persistent spasm was the leading cause of crossover in the radial group followed by radial artery tortuosity. The procedure time of coronary angiography and percutaneous coronary intervention of the ulnar group was significantly higher than that of the radial group (P value = 0.011 and 0.034, respectively). The mean caliber of the right ulnar artery was 2.45 ± 0.38, slightly larger than that of the radial artery 2.33 ± 0.38 at the level of the wrist, but this difference was statistically non-significant. Conclusion Our study demonstrated that ulnar access with experienced radial operators and in our patients is a safe and practical approach for coronary angiography or angioplasty, without any major complications. Bearing in mind its high success rate, it can be used when a radial artery is not useful for the catheterization or as a default approach on the expense of slightly longer procedural time.

P4597Impact of operator experience with radial approach for clinical outcome on percutaneous coronary intervention in acute coronary syndrome performed with femoral artery access site

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tokarek ◽  
A Dziewierz ◽  
K Plens ◽  
T Rakowski ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Femoral Artery ◽  
Coronary Intervention ◽  
Access Site ◽  
Radial Approach ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Percutaneous Coronary

Abstract Introduction Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site. Purpose The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS). Methods A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis. Results The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. <25%: 1.63% (±2.52%) vs. 0.93% (±1.05%) vs. 0.68% (±0.73%) vs. 0.31% (±0.40%); p=0.01). A trend towards higher rate of bleeding at the puncture site during PCI procedures with femoral artery were reported in groups of operators with higher expertise in RA (>75% vs. 50–75% vs. 25–50% vs. <25%: 0.43% (±1.09%) vs. 0.14% (±0.36%) vs. 0.21% (±0.45%) vs. 0.14% (±0.37%); p=0.09). Conclusions Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization. Acknowledgement/Funding None

scholarly journals Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jun Cao ◽  
Huaxiu Cai ◽  
Weibin Liu ◽  
Hengqing Zhu ◽  
Gang Cao
Keyword(s):  
Coronary Angiography ◽  
Success Rate ◽  
Radial Artery ◽  
Meta Analysis ◽  
Artery Occlusion ◽  
Puncture Site ◽  
Randomized Controlled ◽  
Radial Access ◽  
Occlusion Rate ◽  
Radial Artery Occlusion

Objectives. Searching the literature for coronary angiography (CAG) or intervention through distal radial access (DRA) and performing a meta-analysis. Background. Coronary angiography (CAG) or intervention through distal radial access (DRA) may have a similar success rate, low radial artery occlusion rate, low radial artery spasm rate, and low rate of puncture site hematoma for patients with coronary heart disease. Therefore, the randomized controlled trials (RCTs) were searched, and the data were pooled for meta-analysis to evaluate the effectiveness and safety of DRA. Methods. RCTs comparing the CAG or intervention through DRA vs. transradial access (TRA) published between January 1, 2017, and May 4, 2021, were searched in the PubMed, Embase, and Cochrane databases. The endpoints included the rate of access success and the number of radial artery occlusions, radial artery spasms, and puncture site hematomas. The data were extracted, and a random-effects model was used for analysis. Results. Among 204 studies, 6 RCTs (with 2825 participants) met the inclusion criteria. Compared to TRA, the access success rate in DRA ( p = 0.1 ) and the lower rate of puncture site hematoma were not significantly different ( p = 0.646 ), while the radial artery occlusion rate ( p < 0.001 ) and radial artery spasm rate ( p = 0.029 ) were significantly lower. Conclusion. In summary, DRA has a similar access success rate and incidence of hematoma at the puncture site, but a lower incidence of RAO and spasm compared to TRA. These findings demonstrated that DRA is a safe and effective access for CAG or intervention.

Abstract 366: Procedure Change To Reduce Radial Artery Compression Device Bleeding Following Radial-approach Angiography: A Single Centre’s Preliminary Results.

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Vanessa Lee ◽  
Toni Davey ◽  
Ellen Kenny ◽  
Kath Cowie ◽  
Nicholas Cox
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Puncture Site ◽  
Compression Device ◽  
Radial Access ◽  
Initial Volume ◽  
Post Procedure ◽  
Retrospective Audit ◽  
Percutaneous Coronary ◽  
Prolonged Recovery

Background: Radial access is an increasingly common approach to coronary angiography whereby a radial artery compression device (RACD) is applied to achieve haemostasis following sheath removal. Current procedure recommends the removal of 5mL of air at 5-minutely intervals from the RACD; 45 minutes post angiogram sheath removal and 2 hours post PCI (Percutaneous Coronary Intervention) sheath removal. Haemostasis failure at the puncture site however was frequently reported and required re-insertion of air. Patients reported increased discomfort and, in 44% of elective cases, post-procedure stay was increased and discharge delayed by 30-180 minutes as a result of prolonged recovery time. Methods: Hospital procedure was revised to remove 3mL volume (air) at 5-minutely intervals from the RACD instead of 5mL. The RACD was also to remain untouched for 60 minutes post angiogram sheath removal and remained at 2 hours untouched post PCI sheath removal. A retrospective audit was conducted pre- and post-procedure change and included patients undergoing radial-access angiogram or PCI Results: A total of 258 cases were reviewed; 158 angiogram and 100 PCI. Initial volume of air used to achieve haemostasis was 10-18mLs and heparin dose administered was 2000-10,000units. Prior to procedure change, 5mL (air) was removed from the RACD and subsequently haemostasis failure occurred in 43.8% (35) of angiogram patients and 55.1% (27) of PCI patients. Following implementation of the 3mL procedure, haemostasis failure was reported in 12.8% (10) of angiogram patients and 19.6% (10) of PCI patients. Conclusion: Whilst total time taken to remove the RACD marginally increased, decreasing the volume of air removed from 5mL to 3mL significantly reduced the incidence of haemostasis failure. This effect was achieved without adjustment of anticoagulation dose or initial volume of air inserted into the RACD.

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