scholarly journals Radial artery access anatomy: considerations for neuroendovascular procedures

2021 ◽  
pp. neurintsurg-2021-017871
Author(s):  
Kazim H Narsinh ◽  
Mohammed H Mirza ◽  
Madhavi Duvvuri ◽  
M Travis Caton Jr ◽  
Amanda Baker ◽  
...  
Keyword(s):  
Radial Artery ◽  
Great Vessel ◽  
Transradial Approach ◽  
Transradial Access ◽  
Neurointerventional Procedures ◽  
Arterial Anatomy

Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we will review important anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. These include normal and variant radial artery anatomy, the anatomic snuffbox, as well as axillary, brachial, and great vessel arterial anatomy that is imperative for the neuroendovascular surgeon to be intimately familiar prior to pursuing transradial access procedures. In the next part of the review series, we will focus on safety and complications specific to a transradial approach.

scholarly journals Radial artery access for neuroendovascular procedures: safety review and complications

2021 ◽  
pp. neurintsurg-2021-017325 ◽  
Author(s):  
Kazim H Narsinh ◽  
Mohammed H Mirza ◽  
M Travis Caton Jr ◽  
Amanda Baker ◽  
Ethan Winkler ◽  
...  
Keyword(s):  
Radial Artery ◽  
Transradial Approach ◽  
Safety Review ◽  
Transradial Access ◽  
Neurointerventional Procedures

Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we reviewed anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. In this second part of the review series, we aim to (1) summarize evidence for safety of the transradial approach, and (2) explain complications and their management.

Endovascular management of radial artery loop for neuroangiography: Case series

2020 ◽  
pp. 159101992098281
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Michael K Tso ◽  
Justin M Cappuzzo ◽  
Daniel Popoola ◽  
...  
Keyword(s):  
Radial Artery ◽  
Descriptive Analysis ◽  
Case Series ◽  
Endovascular Management ◽  
Transradial Approach ◽  
Significant Challenge ◽  
Radial Loop ◽  
Transradial Access ◽  
Loop Pattern ◽  
Artery Branch

Background Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly. Methods We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure. The loop pattern, the presence of an associated recurrent radial artery branch, navigation technique, and procedure-related complications were recorded. A descriptive analysis was performed. Results A total of 997 transradial approach procedures were performed over a 9-month period. A radial loop was identified in 10 (1.0%) patients. The average age was 68.6 ± 14.3 years. A microcatheter advanced over a microwire was used to navigate the loop and avoid entry into the recurrent branch. A diagnostic neuroangiographic procedure was performed successfully in 8 cases and an intervention was performed successfully in 1 case. A 360° loop was present in 2 of these cases. In each case, transradial access was performed successfully. In 1 other diagnostic case, transradial access was aborted, and the femoral artery was accessed to perform the procedure. Conclusions A radial loop was present in 1% of the cases in this series. Our technical results suggest that this anomaly should not be considered a contraindication to transradial neuroangiography because the procedure was successfully performed in most (9 of 10) cases using a microcatheter system to navigate the loop.

The Rationale for Radial Artery Access in Neurointerventional Surgery

2021 ◽  
pp. 1-8
Author(s):  
Samir Sur ◽  
Stephanie H. Chen ◽  
Pascal M. Jabbour ◽  
Eric C. Peterson
Keyword(s):  
Radial Artery ◽  
Collateral Circulation ◽  
Interventional Cardiology ◽  
Transradial Approach ◽  
Radial Approach ◽  
The Core ◽  
Radial Access ◽  
Ischemic Complications ◽  
Basic Concepts ◽  
Arterial Anatomy

Over 20 years of investigation and experience have gone into pioneering the radial approach for cardiac interventions. This has shown the technique to be superior to the traditional transfemoral technique for a variety of reasons. Neurointerventionalists have until recently been unaware of this innovation and are only starting to use it in their practice. Most of the data from the interventional cardiology journey into radial access is unknown to the neurointerventionalist audience, and concepts that underpin radial access are unfamailiar. Even basic concepts such as radial arterial anatomy, collateral circulation of the hand, and low rates of ischemic complications have been siloed in the cardiology literature. The core rationale for the transradial approach is reviewed.

Transradial access for arteriovenous fistuloplasty in Singapore

2020 ◽  
pp. 112972982094664
Author(s):  
Chee Wui Ong ◽  
Enming Yong ◽  
Qiantai Hong ◽  
Sadhana Chandrasekar ◽  
Lawrence Han Hwee Quek ◽  
...  
Keyword(s):  
Radial Artery ◽  
University Hospital ◽  
Dialysis Access ◽  
Complication Rates ◽  
Artery Pseudoaneurysm ◽  
Transradial Approach ◽  
Technical Success Rate ◽  
Arteriovenous Fistulas ◽  
Transradial Access ◽  
Venous Stenosis

Background: Endovascular balloon angioplasty is standard therapy for dysfunctional arteriovenous fistula in end-stage renal failure patients on hemodialysis. Venous antegrade or retrograde puncture of the fistula is typically performed to gain access for fistuloplasty. Transradial approach for brachiocephalic or brachiobasilic arteriovenous fistulas offers an alternative method of access with the advantage of addressing multi-focal juxta-anastomotic and venous stenosis from the same approach. We aim to review the efficacy, outcomes and complication rates of transradial access for arteriovenous fistuloplasty among patients in Singapore. Methods: A retrospective review of 195 endovascular fistuloplasties from September 2017 to August 2019, at a tertiary university hospital Vascular Surgery unit. Results: Of 195 fistuloplasties, 43 (22%) were transradial approach (23 brachiocephalic arteriovenous fistulas, 20 brachiobasilic arteriovenous fistulas) in 33 patients (67% male and mean age = 65 years). Of these 43 procedures, 11 (26%) were performed as balloon-assisted maturation fistuloplasties while 32 (74%) were performed for mature arteriovenous fistulas with multi-focal juxta-anastomosis and venous stenosis. Technical success rate was 95% with mean procedure duration at 43.5 ± 14.6 min. Mean pre- and post-fistuloplasty dialysis access flow rates increased from 502 to 952 ml/min (p < 0.001). Post-intervention primary patency was 100%, 66% and 20% at 1, 6 and 12 months, respectively. There were four patients with non-limb-threatening radial artery thrombosis (9.3%) while there was no radial artery pseudoaneurysm or post-procedural bleeding. Conclusion: Transradial approach for arteriovenous fistuloplasty is a safe and feasible option in patients requiring balloon-assisted maturation or with multi-focal juxta-anastomotic and venous stenosis.

scholarly journals Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions

2021 ◽  
Vol 12 ◽  
pp. 513
Author(s):  
Maham Ahmed ◽  
Stephanie Zyck ◽  
Grahame C. Gould
Keyword(s):  
Radial Artery ◽  
Small Diameter ◽  
Diagnostic Procedures ◽  
Initial Experience ◽  
Access Site ◽  
Palmar Arch ◽  
Access Site Complication ◽  
Hand Ischemia ◽  
Transradial Access ◽  
Neurointerventional Procedures

Background: Transradial access (TRA) for diagnostic and interventional neuroendovascular procedures has gained significant popularity in recent years due to its improved safety profile and appeal to patients compared with transfemoral access. However, risks of TRA include hand ischemia in cases of poor ulnar collateral circulation and inability to cannulate the radial artery due to its relatively small diameter. By accessing the radial artery distal to the superficial palmar arch where ulnar collateral blood flow arises, in the anatomic snuffbox, the risk of hand ischemia is theoretically eliminated. The use of subcutaneous nitroglycerin and lidocaine to improve rates of success in radial artery access has been reported in the cardiac literature, however, has yet to be described for neurointerventional procedures. We discuss our technique and report our initial experience using subcutaneous nitroglycerin and lidocaine cocktail for access to the distal transradial artery in a variety of neuroendovascular procedures. Methods: A retrospective review of our institution’s database of neurointerventional and diagnostic procedures performed using dTRA was conducted, and 64 patients were identified between February and December 2020. Patient demographics, clinical data, procedural details, and radiographic information were collected and analyzed. Results: A total of 64 patients underwent neurointerventional procedures using the subcutaneous injection for dTRA access. The procedures performed included diagnostic cerebral angiograms (n = 47), stent and balloon assisted aneurysm coiling (n = 5), flow diversion (n = 2), intra-saccular device placement (n = 1), mechanical thrombectomy (n = 1), tumor embolization (n = 1), middle meningeal artery embolization (n = 2), extracranial carotid stent placement (n = 2), and arteriovenous malformation embolization (n = 3). While no complications of hand ischemia were appreciated, the access site conversion rate was 3.1%; 2 cases required a switch to femoral artery access due to proximal vessel tortuosity and aortic anatomical variations, and not due to access site complication. Furthermore, on repeat angiograms by the same proceduralist, distal TRA (dTRA) was successful in 100% of the cases. Conclusion: dTRA using subcutaneous nitroglycerin and lidocaine is a safe and effective method for neurointerventional and diagnostic procedures.

Access-site complications of the transradial approach: Rare but still there.

2020 ◽  
Vol 16 ◽  
Author(s):  
Stelina Alkagiet ◽  
Dimitrios Petroglou ◽  
Dimitrios N. Nikas ◽  
Theofilos M. Kolettis
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Tissue Loss ◽  
Access Site ◽  
Transradial Approach ◽  
Financial Benefits ◽  
Eversion Endarterectomy ◽  
Life Threatening ◽  
Sheath Insertion ◽  
Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

scholarly journals Anxiety score as a predictor of radial artery spasm during transradial approach for percutaneous coronary intervention

2018 ◽  
Vol 70 ◽  
pp. S71
Author(s):  
Krishnarpan Chatterjee ◽  
Naveen Garg ◽  
Umamaheshwar K. L ◽  
Roopali Khanna ◽  
Aditya Kapoor ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Anxiety Score ◽  
Transradial Approach ◽  
Percutaneous Coronary

scholarly journals Transradial approach to embolization of a basilar aneurysm: a clinical case and literature review

2019 ◽  
Vol 20 (4) ◽  
pp. 61-67
Author(s):  
D. V. Kandyba ◽  
K. N. Babichev ◽  
A. V. Zenin
Keyword(s):  
Blood Flow ◽  
Radial Artery ◽  
Clinical Case ◽  
Study Objective ◽  
Arterial Access ◽  
Vertebrobasilar System ◽  
Transradial Access ◽  
Aneurysm Embolization ◽  
Reduced Rate ◽  
Large Aneurysm

The study objective is to present a clinical case of using transradial access for embolization of an aneurysm of the basilar artery (BA) bifurcation. Materials and methods. A patient, 67 years old, sought medical help at the I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine complaining of headaches. Computed angiography of the brain had shown a large aneurysm of the BA with an absolutely wide neck. Embolization of the aneurysm using stent assistance (Y-stenting) was performed with access through the radial artery. The results were compared to data from scientific literature (about 16 cases).Results. Aneurysm embolization level was II or IIIb per the modified Raymond–Roy classification was performed. No complications were observed, blood flow in the radial artery was preserved. The patient was released on day 2 after the surgery. No signs of blood flow through the aneurysm were observed during control selective cerebral angiography 12 months later. According to literature data, transradial access is preferable only with pathology of the vertebrobasilar system, especially if standard access is impossible to form due to atherosclerotic damage of the femoral artery, angling of the aortic arch, and pathological vessel tortuosity.Conclusion. Routine use of transradial access in surgery of pathologies of the cerebral flow is not justifiable. But in some cases, this alternative access can be more effective and safer compared to the standard access. The main advantages of this access are reduced rate of complications of arterial access and possibility of early patient activization.

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