Access Through the Anatomical Snuffbox for Neuroendovascular Procedures: A Single Institution Series

2020 ◽  
Vol 19 (5) ◽  
pp. 495-501 ◽  
Author(s):  
Joshua H Weinberg ◽  
Ahmad Sweid ◽  
Omaditya Khanna ◽  
Nikolaos Mouchtouris ◽  
Ashlee Asada ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Radial Artery ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Safe Alternative ◽  
Access Site Complication ◽  
Size Number ◽  
Therapeutic Procedures ◽  
The Mean ◽  
Transradial Catheterization

Abstract BACKGROUND Distal transradial catheterization in the anatomic snuffbox is an alternate route of access that has started to gain consideration for neuroendovascular procedures. OBJECTIVE To assess the feasibility and outcomes and present our institution's experience in performing neuroendovascular procedures via distal transradial access (dTRA). METHODS We conducted a retrospective analysis and identified 120 patients who underwent consecutive neuroendovascular procedures via dTRA in the anatomic snuffbox. Data collection was performed on indication for procedure, sheath size, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success. RESULTS Of 120 patients with an average age of 54.7 yr ± 14.7, 73 (60.8%) underwent diagnostic angiograms, 38 (31.7%) underwent follow-up angiograms, and 9 (7.5%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.5 ± 0.1 per procedure, the mean procedure time was 68.3 min ± 43.4, the mean fluoroscopy time was 10.8 min ± 7.6, the mean contrast dose was 70.6 mL ± 39.1, and the mean radiation exposure was 27 672.2 mGycm2 ± 42 728.4. Successfully completed therapeutic procedures included aneurysm 1 (0.8%), arteriovenous malformation (AVM)/arteriovenous fistula/carotid cavernous fistula 7 (5.8%), and 1 (0.8%) other treatment. Three patients (2.5%) required adjunct transfemoral endovenous access for AVM embolization. Two minor complications (1.67%) were a local wrist hematoma and a radial artery vasospasm without any sequelae. CONCLUSION Distal radial artery catheterization in the anatomic snuffbox is a safe and effective access site to perform neuroendovascular procedures. Complications and conversion rate are low making it a safe alternative.

Abstract WMP2: Pearls and Pitfalls of the Transradial Approach for Neurointerventions: Lessons Learned After 570 Cases

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ahmad Sweid ◽  
Omaditya Khanna ◽  
Somnath Das ◽  
Julie Kim ◽  
Darcy Curtis ◽  
...  
Keyword(s):  
Radial Artery ◽  
Lessons Learned ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Safe Alternative ◽  
Transradial Approach ◽  
Access Site Complication ◽  
Wide Range ◽  
Therapeutic Procedures ◽  
Web Device

Background and Purpose: Trans radial catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures. There are several randomized controlled trials from cardiac field that had established its safety and efficacy. We present our institution’s experience in performing neuroendovascular interventions via a transradial approach. Methods: We conducted a retrospective analysis and identified 570 patients who underwent consecutive neuroendovascular interventions via radial artery access. Data collection was performed on indication for procedure, sheath size, catheter type, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success. Results: Of 570 patients with an average age of 59.4 years ± 14.7, 406 (71.2%) underwent diagnostic angiograms and 164 (28.7%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.9 ± 1.7 per procedure. The RCCA was the most frequent selectively catheterized artery; 340 (22.9%), followed by LCCA; 306 (20.6%), RICA; 250 (16.8%), LICA; 238 (16.0%), RVA; 159 (10.71%), LVA; 76 (5.1%), RECA; 61 (4.1%), and lastly the LECA selectively catheterized in 54 (3.6%). The average amount of contrast given was 83.4 cc ± 51.Successfully completed therapeutic procedures included aneurysm simple coiling (34 patients), stent assisted coiling (30 patients), flow diversion (34) patients), ICA balloon angioplasty and stenting (20 patients), Web device (8), AVM embolization (14), IAC for retinoblastoma (1 patient), and stroke thrombectomy (23 patients). The average duration was 72 mins ± 43, and average fluoroscopy time was 13.20 mins ± 11.20. Seventeen patients (3.2%) required conversion to transfemoral access. Twelve minor complications (2.3%) were reported including mild oozing after deflation of the balloon, ecchymosis, mild swelling. No major complications were encountered. Conclusions: Radial artery catheterization is a safe and effective access site to perform a wide range of diagnostic and therapeutic procedures. Complication and conversion rate are low making it a safe alternative.

Transradial cerebral angiography becomes more efficient than transfemoral angiography: lessons from 500 consecutive angiograms

2021 ◽  
pp. neurintsurg-2021-017391
Author(s):  
D Andrew Wilkinson ◽  
Neil Majmundar ◽  
Joshua S Catapano ◽  
Vance L Fredrickson ◽  
Daniel D Cavalcanti ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cerebral Angiography ◽  
Fluoroscopy Time ◽  
Procedure Time ◽  
Single Center ◽  
Access Site ◽  
Arterial Access ◽  
Diagnostic Angiography ◽  
The Mean ◽  
Intent To Treat

BackgroundTransradial arterial access (TRA) for cerebral diagnostic angiography is associated with fewer access site complications than transfemoral access (TFA). However, concerns about increased procedure time and radiation exposure with TRA may slow its adoption. Our objective was to measure TRA rates of success and fluoroscopy time per vessel after ‘radial-first’ adoption and to compare these rates to those obtained with TFA.MethodsWe examined 500 consecutive cerebral angiograms on an intent-to-treat basis during the first full year of radial-first adoption, recording patient and procedural characteristics and outcomes.ResultsOver a 9-month period at a single center, 457 of 500 angiograms (91.4%) were performed with intent-to-treat via TRA, and 431 cases (86.2%) were ultimately performed via TRA. One patient (0.2%) experienced a temporary neurologic deficit in the TRA group, and none (0%) did in the TFA group (p=0.80). The mean±SD fluoroscopy time per vessel decreased significantly from the first half of the study to the second half for TRA (5.0±3.8 vs 3.4±3.5 min/vessel; p<0.001), while TFA time remained unchanged (3.7±1.8 vs 3.5±1.4 min/vessel; p=0.69). The median fluoroscopy time per vessel for TRA became faster than that for TFA after 150 angiograms.ConclusionOf 500 consecutive angiograms performed during the first full year of radial-first implementation, 86.2% were performed successfully using TRA. TRA efficiency exceeded that of TFA after 150 angiograms. Concerns about the length of procedure or radiation exposure should not be barriers to TRA adoption.

scholarly journals A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

2021 ◽  
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Kory B. Dylan Pasko
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Hip Arthroplasty ◽  
Fluoroscopy Time ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Preoperative Templating ◽  
The Mean ◽  
Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

Utility of Suprasternal Transinnominate Artery for Alternate Access in Transcatheter Aortic Valve Replacement

2020 ◽  
pp. 155698452096765
Author(s):  
James H. Wudel ◽  
Sagar Damle ◽  
Joseph V. Petty ◽  
Anuradha Tunuguntla ◽  
Steven L. Martin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Access Site ◽  
Access Site Complication ◽  
Single Center Experience ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
The Mean

Objective Despite advancements in transcatheter aortic valve replacement (TAVR) technology, alternate access strategies are still required when transfemoral access is unsuitable. In these often anatomically complex group of patients, we sought to evaluate the safety and feasibility of suprasternal transinnominate (TI) artery access for TAVR. Methods At our institution, 652 patients underwent TAVR from November 2011 through February 2020. Of these, 23 patients underwent TI TAVR via a 5-cm suprasternal incision without special instrumentation. Outcomes of interest were technical considerations, postoperative complications, and perioperative recovery in relation to established access strategies. Results The mean Society of Thoracic Surgeons risk score was 8.6 ± 4.2 and the average age was 75 ± 8. All patients underwent TI TAVR using a self-expanding (12), or balloon-expandable (11) transcatheter heart valve. Average postoperative stay was 2 ± 0.7 days (range 2 to 4) with most 20/23 (87%) being discharged to home. There was no 30-day mortality or readmission. There was 1 access-site complication and 1 cerebrovascular accident within 30 days, both intraoperative, with excellent recovery. All patients had either trivial (19) or mild (4) aortic regurgitation on 30-day echocardiography. Conclusions TAVR via suprasternal TI access is feasible, safe, provides satisfactory perioperative recovery and adds to the options when patients require alternate access. Further data would be optimal to validate this single-center experience.

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

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 74-82 ◽  
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.

scholarly journals Does a fluoro-assisted direct anterior approach for total hip arthroplasty pose an excessive risk of radiation exposure to the surgeon?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 6
Author(s):  
Yuta Jinnai ◽  
Tomonori Baba ◽  
Xu Zhuang ◽  
Hiroki Tanabe ◽  
Sammy Banno ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Proximal Femoral Fracture ◽  
Fluoroscopy Time ◽  
Exposure Level ◽  
Intraoperative Fluoroscopy ◽  
Significant Difference ◽  
The Mean

Introduction: Intraoperative fluoroscopy can be easily used because patients are placed in the supine position during total hip arthroplasty via direct anterior approach (DAA-THA) to reduce complications. However, the cumulative level of radiation exposure by intraoperative fluoroscopy increases as the annual number of cases increases, increasing the risk of influencing the health of both the patients and medical workers. The objective of the study was to compare the radiation exposure time of DAA-THA with osteosynthesis and to determine if the level of radiation exposure exceeded safety limits. Material and methods: DAA-THA was performed in 313 patients between January 2016 and July 2018 and 60 patients with proximal femoral fracture were treated with osteosynthesis. The intraoperative fluoroscopy time was retrospectively surveyed and compared between these two groups. A total of eight surgeons operated DAA-THA employing the same procedure using a traction table. A total of nine surgeons operated osteosynthesis and fluoroscopy was appropriately used during reduction and implant insertion. Results: The mean operative time of DAA-THA was 103.3 min and that of osteosynthesis was 83.3 min, showing a significant difference (p < 0.05). The mean intraoperative fluoroscopy time was 0.83 min (SD ± 0.68) in DAA-THA and 8.91 min (SD ± 8.34) in osteosynthesis showing a significant difference (p < 0.05). Conclusions: The intraoperative exposure level was significantly lower and the fluoroscopy time was significantly shorter in DAA-THA than in osteosynthesis for proximal femoral fracture. It was clarified that the annual cumulative radiation exposure level in DAA-THA does not exceed the tissue dose limit.

scholarly journals Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

2014 ◽  
Vol 8 (9-10) ◽  
pp. 347 ◽  
Author(s):  
Andrea G Lantz ◽  
Padraic O'Malley ◽  
Michael Ordon ◽  
Jason Y Lee
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Percutaneous Nephrolithotomy ◽  
Treatment Success ◽  
Fluoroscopy Time ◽  
Success Rates ◽  
Stone Size ◽  
Lower Treatment ◽  
The Mean ◽  
Stone Characteristics

Introduction: Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopytime, effective dose) and investigates variables that may predict increased exposure.Methods: A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure.Results: In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m2 and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose.Conclusions: Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Ruzsa ◽  
N Sandor ◽  
J Toth ◽  
M Deak ◽  
B Zafirovska ◽  
...  
Keyword(s):  
Radial Artery ◽  
Subclavian Artery ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Access Site Complication ◽  
Radial Access ◽  
Angiographic Data ◽  
Procedural Complications ◽  
Radial Artery Occlusion

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&lt;0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

Radiation exposure during non-thrombotic iliac vein stenting

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Jesse Chait ◽  
Nikolay Davis ◽  
Yuriy Ostrozhynskyy ◽  
Sareh Rajaee ◽  
Natalie Marks ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Intravascular Ultrasound ◽  
Stent Placement ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Vena Cava ◽  
Iliac Vein ◽  
Fluoroscopy Time ◽  
Air Kerma ◽  
The Mean

Objective Fluoroscopic-guided interventions have become a major part of the modern vascular surgeon’s practice. Imaging is typically required to safely and effectively perform both simple and complex endovascular interventions. With an ever-increasing volume of fluoroscopic-guided interventions being performed each year, the minimization of harmful radiation exposure has become of paramount concern for both patients and providers. The purpose of this study was to identify the extent of radiation exposure associated with venography and iliac vein stenting, an intervention utilized in the management of chronic venous insufficiency. Methods This was a single-center, retrospective analysis of 40 venograms performed on 29 unique patients over a three-month period. Patients with signs and symptoms of chronic venous insufficiency who failed conservative therapy underwent evaluation of the vena cava and iliofemoral veins with venography and intravascular ultrasound. Stent placement was performed if a >50% cross-sectional area or diameter reduction was identified via intravascular ultrasound. All patients were found to have non-thrombotic iliac vein lesions. All patients wore two individual film badge dosimeters – one on their chest and the other on the abdomen. The same mobile C-arm system was used for all interventions. Results There were 15 males and 14 females, with an average age of 70.6 years old (SD ± 9.5; range 53–89) and a mean body mass index of 33.9 kg/m2. Sixteen limbs had C6 disease, 10 had C4 disease, and 14 had C3 disease. Thirty-eight of the 40 procedures resulted in stent placement, with an average of 1.13 stents placed per intervention. The average fluoroscopy time was 76.5 s (SD ± 36.9; range 7.8–209.5), and the mean cumulative air kerma was 1.08 mGy (SD ± 0.55; range 0.362–2.24). Average cumulative air kerma was higher in procedures resulting >1 stent placement compared to those with placement of ≤1 stent (1.44 vs. 1.02 mGy; p = 0.04). Fluoroscopy time was also higher in procedures with >1 stent placed (120.1 vs. 68.8 s; p = 0.0004). The mean deep dose equivalent per procedure from the patient-worn abdominal badge was 0.221 mSv. Conclusion With the adjunctive use of intravascular ultrasound, iliac vein stenting can be safely and effectively performed with very low utilization of fluoroscopy, and therefore radiation exposure can be minimized for both patients and surgeons. Placement of >1 iliac vein stent resulted in higher cumulative air kerma and fluoroscopy time.

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