Distal or Traditional Transradial Access Site for Coronary Procedures

Background and Purpose: Transradial access (TRA) for neuroendovascular procedures is increasing in prevalence, although numerous procedures are still performed using transfemoral access (TFA). Some cardiology studies have suggested the safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in TFA vascular access site complications (VASCs) associated with radial adoption, the so-called “radial paradox.” We studied the effect of TRA adoption on TFA performance and VASC rates in neuroendovascular procedures. Methods: Data were collected for all neuroendovascular procedures performed over a 10-month period by trainees after implementation of a radial-first paradigm at a single center. Results: Over the study period, 1,084 procedures were performed, including 689 (63.6%) via TRA and 395 (36.4%) via TFA. In comparison to TRA, TFA cases were performed in older patients (TFA 63 ±15 vs. TRA 56 ±16), were predominantly male (TFA 52.9% vs. TRA 38.6%), used larger sheath sizes (≥7 French, TFA 56.6% vs. TRA 2.3%), were more often emergent (TFA 37.7% vs. TRA 1.1%), and used tPA administration (TFA 15.3% vs. TRA 0%) (p<.001 for all comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA 4.6% [18/395] vs. TRA 1.3% [9/689], p=.002) and 2 major (TFA 0.3% [1/395] vs. TRA 0.1% [1/689], p>.99) complications. After multivariate analysis, independent predictors of any VASC included TFA (OR 2.8, 95% CI 1.1-7.4) and use of dual antiplatelets (OR 4.2, 95% CI 1.6—11.1). Conclusions: TFA remains an essential route for neuroendovascular procedures, accounting for 36.4% of cases under a radial-first paradigm. TFA is disproportionately performed in patients undergoing procedures with an increased-risk for VASCs, though the minor and major VASC rates are comparable to historical controls. TFA proficiency may still be achieved in radial-first training without an increase in femoral complications.

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Anomalous Medial Branch of Radial Artery: A Rare Variant

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.98 ◽

2016 ◽

Vol 59 (3) ◽

pp. 100-103 ◽

Cited By ~ 1

Author(s):

Surbhi Wadhwa ◽

Vandana Tomar

Keyword(s):

Radial Artery ◽

Anatomical Variations ◽

Medial Branch ◽

Normal Pattern ◽

Access Site ◽

Capillary Vessel ◽

Radial Forearm ◽

Coronary Procedures ◽

Technical Failures ◽

Flexor Carpi Radialis Muscle

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.

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Republished: Manual reduction of a radial artery loop under direct fluoroscopic visualization

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017665.rep ◽

2021 ◽

pp. neurintsurg-2021-017665.rep

Author(s):

Evan Luther ◽

Eric Huang ◽

Hunter King ◽

Michael Silva ◽

Joshua Burks ◽

...

Keyword(s):

Radial Artery ◽

Preoperative Embolization ◽

Access Site ◽

Antecubital Fossa ◽

Femoral Access ◽

Manual Reduction ◽

Transradial Access ◽

Guide Catheter ◽

Manual Manipulation ◽

Standard Techniques

Transradial access has become increasingly used in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70 s who underwent preoperative embolization of a carotid body tumor via right transradial access. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop allowing the procedure to continue transradially. Although a majority of radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method before converting the access site.

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Learning curves for transradial access versus transfemoral access in diagnostic cerebral angiography: a case series

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017460 ◽

2021 ◽

pp. neurintsurg-2021-017460

Author(s):

Michael K Tso ◽

Gary B Rajah ◽

Rimal H Dossani ◽

Michael J Meyer ◽

Matthew J McPheeters ◽

...

Keyword(s):

Learning Curve ◽

Case Series ◽

Learning Curves ◽

Fluoroscopy Time ◽

Access Site ◽

Steep Learning Curve ◽

Transradial Access ◽

Primary Operator ◽

Technical Proficiency ◽

Over Time

BackgroundThe perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications.ObjectiveTo compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator.MethodsThe first 100–150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified. Mean fluoroscopy time per artery injected (angiographic efficiency) was calculated as a marker of technical proficiency and compared for every 25 consecutive procedures performed (eg, 1–25, 26–50, 51–75).ResultsWe identified 1242 diagnostic angiograms, 607 transradial and 635 transfemoral. The radial cohort was older (64.3 years vs 62.3 years, p=0.01) and demonstrated better angiographic efficiency (3.4 min/vessel vs 3.7 min/vessel, p=0.03). For three fellows without previous endovascular experience, proficiency was obtained between 25 and 50 transfemoral angiograms. One fellow achieved proficiency after performing 25–50 transradial angiograms; and the two other fellows, in <25 transradial angiograms. The two fellows with previous experience had flattened learning curves for both access types. Two patients experienced transient neurologic symptoms postprocedure. Transradial angiograms were associated with significantly fewer access-site complications (3/607, 0.5% vs 22/635, 3.5%, p<0.01). Radial-to-femoral conversion occurred in 1.2% (7/607); femoral-to-radial conversion occurred in 0.3% (2/635). Over time, the proportion of transradial angiographic procedures increased.ConclusionTechnical proficiency improved significantly over time for both access types, typically requiring between 25 and 50 diagnostic angiograms to achieve asymptomatic improvement in efficiency. Reduced access-site complications and decreased fluoroscopy time were benefits associated with transradial angiography.

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Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Cardiology ◽

10.1159/000488852 ◽

2018 ◽

Vol 140 (2) ◽

pp. 74-82 ◽

Cited By ~ 3

Author(s):

Matteo Tebaldi ◽

Simone Biscaglia ◽

Carlo Tumscitz ◽

Annamaria Del Franco ◽

Francesco Gallo ◽

...

Keyword(s):

Radial Artery ◽

Primary Outcome ◽

Study Groups ◽

Adjunctive Treatment ◽

Access Site ◽

Double Blind ◽

Access Site Complication ◽

Heparin Administration ◽

Coronary Procedures ◽

Sheath Insertion

Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery occlusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

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Endovascular Radial Artery Sacrifice in an Unsalvageable Transradial Access Site Bleeding due to Cutting Balloon Angioplasty

Annals of Vascular Diseases ◽

10.3400/avd.cr.18-00081 ◽

2019 ◽

Vol 12 (2) ◽

pp. 240-242

Author(s):

Loy Liang Meng ◽

Uei Pua

Keyword(s):

Radial Artery ◽

Balloon Angioplasty ◽

Cutting Balloon ◽

Access Site ◽

Transradial Access ◽

Cutting Balloon Angioplasty

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Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis

BMC Cardiovascular Disorders ◽

10.1186/s12872-015-0022-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 8

Author(s):

Pei-Jung Wu ◽

Yu-Tzu Dai ◽

Hsien-Li Kao ◽

Chin-Hao Chang ◽

Meei-Fang Lou

Keyword(s):

Access Site ◽

Vascular Closure Devices ◽

Coronary Procedures

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From Femoral to Radial Approach in Coronary Intervention

Angiology ◽

10.1177/0003319716656714 ◽

2016 ◽

Vol 68 (4) ◽

pp. 281-287 ◽

Cited By ~ 11

Author(s):

Renatomaria Bianchi ◽

Ludovica D’Acierno ◽

Mario Crisci ◽

Donato Tartaglione ◽

Maurizio Cappelli Bigazzi ◽

...

Keyword(s):

Cost Effectiveness ◽

Coronary Angiography ◽

Coronary Intervention ◽

Access Site ◽

Femoral Access ◽

Transradial Approach ◽

Operator Experience ◽

Transradial Access ◽

Hemorrhagic Events ◽

Duration Of Hospitalization

Since the first cardiac catheterization in 1929, this procedure has evolved considerably. Historically performed via the transfemoral access, in the last years, the transradial access has been spreading gradually due to its many advantages. We have conducted a review of published literature concerning efficacy, safety, and cost-effectiveness, and we analyzed our patients’ data, including the results of the recently published Minimizing Adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX (MATRIX) study. This review confirmed the superiority of the transradial access compared to the femoral access, especially regarding complications related to the access site, duration of hospitalization, and comfort for the patient. The transradial approach is an excellent option for coronary angiography, and the procedure’s risks are reduced by increased operator experience.

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