Abstract 1122‐000162: Distal Radial Access Learning Curve Spanning Eighty Attempts: A Single‐Center, Single‐Operator Experience

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ivo Bach ◽  
Pratit Patel ◽  
Taha Nisar ◽  
Amit Singla ◽  
Priyank Khandelwal
Keyword(s):  
Radial Artery ◽  
Retrospective Chart Review ◽  
Artery Occlusion ◽  
Patient Comfort ◽  
Total Radiation ◽  
Shoulder Injuries ◽  
Operator Experience ◽  
Radial Access ◽  
Significant Difference ◽  
Single Operator

Introduction : The transradial approach (TRA) has recently been adopted by neurointerventionalists and is now widely used. Among some of the benefits of TRA are reduced access site complications, increased patient comfort, earlier ambulation, and decreased time for postprocedural monitoring. The Distal transradial access method (dTRA) involves accessing the radial artery via the anatomic snuffbox and is practiced due to the belief that it may mitigate some of the complications seen with conventional TRA including but not limited to hand positioning, patient comfort (especially in those with shoulder injuries), and radial artery occlusion. Methods : A retrospective chart review was done of all patients on whom dTRA was performed between October 2018 until March 2020. Procedures were performed by 1 neuroendovascular fellow under the supervision of 2 neuroendovascular attendings. Although the number of cases was counted serially, cases were excluded from analysis if there was occlusion of the radial artery, aberrant origin of the subclavian artery was present, or if there was an intervention other than just diagnostic angiography (including but not limited to stenting, coiling, mechanical thrombectomy, intra‐arterial verapamil for cerebral vasospasm). Procedures were performed under local anesthetic and conscious sedation. Patient demographics, procedural complications, procedural time, total fluoroscopy time, and total radiation were collected. Results : Fifty‐seven cases were included in the analysis. The age of the patients ranged from 16 to 78. Thirty‐one cases out of the included cases were outpatient same‐day procedures. The total length of stay in these cases was a total of 444 minutes or 7.4 hours and they were discharged 213 minutes or 3.55 hours following the procedure on average. The highest rate of improvement in total fluoroscopy per vessel, total radiation per vessel, and case time per vessel occurs in the first 50 cases. When the 57 cases were broken down into 3 groups of 19and analyzed with ANOVA there was a significant difference between groups (Fluoro per Vessel p = 0.0003, Total radiation per vessel p = 0.0001, Duration of case per vessel p = 0.05). No major complications or significant bleeding were noted post‐procedurally. Vasospasm was the most common complication occurring in 5 and occurred within the first 25 cases. Conversion to conventional radial occurred in 4 of 57 cases. Two cases were converted due to vasospasm and 2 due to the inability to successfully puncture. Conclusions : Distal radial access in the anatomical snuffbox has been shown to have some benefits over conventional radial access. For those willing to adopt this practice, we have shown that a single operator can expect the greatest improvement within the first 50 cases.

Description of Technique and Short-Term Outcomes of Radial Artery Access for Vascular Disease

2020 ◽  
Vol 54 (4) ◽  
pp. 319-324
Author(s):  
Ali Khalifeh ◽  
Besher Tolaymat ◽  
Joseph Noggle ◽  
Richa Kalsi ◽  
Christine Owen ◽  
...  
Keyword(s):  
Radial Artery ◽  
Endovascular Procedures ◽  
Perioperative Complications ◽  
Vascular Complications ◽  
Retrospective Chart Review ◽  
Patient Comfort ◽  
Complication Rates ◽  
Arterial Access ◽  
Radial Access ◽  
Manual Pressure

Objectives: Radial artery access is widely utilized in coronary angiography with reported lower rates of vascular complications and better patient comfort. There is limited data in the literature regarding radial access in peripheral endovascular procedures. We hypothesize that radial access is safe and feasible for peripheral endovascular procedures. Methods: A retrospective chart review was performed for all patients who underwent angiography using radial artery access between August 2013 and December 2017. Patient demographics and perioperative data were recorded and analyzed. Patient Selection: The operating surgeon screened patients presenting for elective angiography for possible radial artery access. Ultrasound guidance was used in all cases. Upon cannulation, the sheath was infused with an antispasmodic cocktail, and the patients were systemically anticoagulated. Results: Forty-seven out of 52 patients successfully completed their procedure (90% success rate). The patients were mostly female (60%), elderly (mean age of 71 years), and had several comorbidities. Preoperative diagnoses were variable. Procedures were both diagnostic (58%) and interventional (42%) with maximum sheath size used being 7F and median fluoroscopy time of 7.5 minutes. Only 2 patients experienced perioperative complications, and both of these were minor hematomas that resolved with manual pressure. Conclusions: Transradial arterial access for peripheral vascular angiography and interventions is safe and feasible. With low complication rates and increased patient comfort, transradial access serves as an excellent alternative to transfemoral access for a variety of endovascular procedures.

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.

Left transradial access for cerebral angiography

2019 ◽  
Vol 12 (4) ◽  
pp. 427-430 ◽  
Author(s):  
Guilherme Barros ◽  
David I Bass ◽  
Joshua W Osbun ◽  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Vascular Complications ◽  
Cerebral Aneurysms ◽  
Retrospective Chart Review ◽  
Interventional Cardiology ◽  
Distal Catheter ◽  
Radial Access ◽  
Transradial Access ◽  
Clinical Scenarios

IntroductionTransradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to cerebral angiography across three institutions.MethodsA retrospective chart review was performed for patients who underwent cerebral angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time.ResultsNineteen patients underwent a total of 25 cerebral angiograms via left transradial access for cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications.ConclusionsLeft transradial access in diagnostic and interventional cerebral angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.

scholarly journals Metode Barbeau Test dalam Menilai Keutuhan Arteri Radialis Pascaintervensi Koroner Perkutan

1970 ◽  
Vol 2 (1) ◽  
Author(s):  
Nurhusna N ◽  
F Sri Susilaningsih ◽  
Purwo Suwigjo
Keyword(s):  
Radial Artery ◽  
Cardiac Catheterization ◽  
Quantitative Research ◽  
Clinical Observation ◽  
Vascular Complications ◽  
Artery Occlusion ◽  
Vascular Complication ◽  
Test Method ◽  
Significant Difference ◽  
Radial Artery Occlusion

Radial artery occlusion merupakan salah satu komplikasi vaskular postkateterisasi jantung trans radial. Kompresi lokal menggunakan alat kompresi setelah tindakan kateterisasi jantung trans radial dapat menurunkan angka kejadian komplikasi vaskular Radial Artery Occlusion(RAO). Penelitian ini bertujuan untuk mengetahui perbandingan antara metode Barbeau test dan metode pengamatan klinik dalam menilai keutuhan arteri radialis selama proses kompresi pada pasien postprosedur kateterisasi jantung trans radial. Penelitian ini merupakan penelitian kuantitatif dengan desain studi komparatif. Subjek penelitian adalah 20 pasien yang menjalani prosedur kateterisasi jantung dengan akses arteri radialis. Pengukuran dilakukan secara bertahap menit ke-15 dan setelah tiga jam menggunakan alat kompresi stepty-p. Uji komparasi menggunakan uji McNemar. Data univariat dianalisis menggunakan distribusi frekuensi. Hasil uji statistik menunjukkan ada perbedaan penilaian keutuhan arteri radialis antara metode Barbeau testdengan metode pengamatan klinik pada menit ke-15 (p=0.035) dan ke-30 (p=0.035). Namun secara keseluruhan hasil uji statistik menunjukkan tidak ada perbedaan yang bermakna dalam menilai kepatenan arteri pada setiap waktu pengamatan dari kedua metode. Kata kunci:Arteri radialis, Barbeau test, kateterisasi jantung, keutuhan, pengamatan klinik AbstractRadial artery occlusion is one of the trans radial vascular complications post cardiac catheterization. The local compression using compression methods after cardiac catheterization can be reduced the vascular complication such as radial artery occlusion (RAO). This research was conducted to determine the comparison between the Barbeau test method and the clinical observation method carried out by the researcher in order to examine the patency of radial artery during compression, post procedure cardiac catheterization at the Angiography Coroner Unit and the Cardiac Intensive Care Unit, Hasan Sadikin Bandung General Hospital, Indonesia. This research was a quantitative research using the comparative study design. The subjects were 20 patients who took cardiac catheterization procedure using radial artery access and checked in pairs. The measurement divided into two periods: the fifteenth minute and the third hour using the stepty-p compression tool. The statistical test used the McNemar test to analyze the comparison, and the single variable data were analyzed using the distribution frequency. There were a significant difference in radial artery evaluation during compression period between two methods, in which at the first fifteen minutes (p=0.035) and the first thirty minutes (p=0.035), respectively. Overall, the result shows that there were no significant difference in comparison of two methods. Key words:Barbeau test, cardiac catheterization, clinical observation, patency, radial artery

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

Safety and feasibility of ulnar artery access for neuroangiography and neurointervention: a case series

2020 ◽  
pp. neurintsurg-2020-016416
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Michael K Tso ◽  
Gary B Rajah ◽  
Daniel Popoola ◽  
...  
Keyword(s):  
Radial Artery ◽  
Descriptive Analysis ◽  
Case Series ◽  
Ulnar Artery ◽  
Middle Meningeal Artery ◽  
Artery Occlusion ◽  
Femoral Access ◽  
Radial Access ◽  
Diagnostic Angiography ◽  
Neurointerventional Procedures

BackgroundRadial access has become popular among neurointerventionalists because it has favorable risk profiles compared with femoral access. Difficulties in accessing or navigating the radial artery have been viewed as a reason to convert to femoral access, but ulnar artery access may prevent complications associated with transfemoral procedures.ObjectiveTo evaluate the safety and feasibility of ulnar access for neurointerventions and diagnostic neuroangiographic procedures.MethodsConsecutive patients who underwent diagnostic angiography or neurointerventional procedures via ulnar access between July 1, 2019 and April 15, 2020 were included. Data recorded were demographics, procedure indication, devices, technique, and complications. Descriptive analysis was performed.ResultsUlnar artery access was obtained for 21 procedures in 18 patients (mean age 70.3±7.8 years; nine men). Procedures included 13 diagnostic angiograms and eight neurointerventions (3 left middle meningeal artery embolization, 1 of which was aborted; 2 carotid artery stenting; 2 angioplasty; 1 mechanical thrombectomy for in-stent thrombosis). A right-sided approach with ultrasound guidance was used for all cases except one. Indications included small caliber radial artery (n=9), radial artery occlusion (n=10), and radial artery preservation for potential bypass (n=2). A 5-French slender sheath was used for diagnostic angiography; a 6-French slender sheath was used for neurointerventions. No case required conversion to femoral access. Two patients had minor hematomas after the procedure; one other had ulnar artery occlusion on 30-day ultrasonography.ConclusionUlnar access is safe and feasible for diagnostic and interventional neuroangiographic procedures. It provides a useful alternative to radial access, potentially avoiding complications associated with femoral access.

P6524The comparison of radial artery occlusion rate after distal radial artery puncture between hemodialysis and non-hemodialysis patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Yokota ◽  
K Tobita ◽  
T Hayashi ◽  
Y Mashimo ◽  
H Miyashita ◽  
...  
Keyword(s):  
Radial Artery ◽  
Hemodialysis Patients ◽  
Artery Occlusion ◽  
Dialysis Patients ◽  
Puncture Site ◽  
Single Center Study ◽  
Significant Difference ◽  
Radial Artery Occlusion ◽  
Event Rates ◽  
Distal Radial Artery

Abstract Background In recent years it has been attempted to use a distal radial artery (DRA) as a puncture site for cardiac catheterization and intervention. A patency of radial artery is important in hemodialysis patients because the radial artery is source as an arteriovenous shunt. However, the incidence of radial artery occlusion (RAO) is not known after DRA puncture. Purpose To compare RAO rates after DRA puncture between dialysis and non-dialysis patients. Method This was retrospective, observational and single center study. All consecutive 1,533 patients undergoing DRA puncture were analyzed. The primary endpoint is RAO rates. The secondary endpoint is composite bleeding adverse event rates. These endpoints were evaluated by a vascular echocardiography several hours or the next day after the procedure. Result Among 1,533 patients, 26 were dialysis patients and 1,504 were non-dialysis patients. 1,386 people (90.5%) succeeded in puncture. Radial artery occlusion occurred in 7 patients (0.4%), all of whom were non-dialysis patients. There was no significant difference of RAO rate in dialysis patients and non-dialysis patients. Conclusion When performing DRA puncture, the probability of radial artery occlusion is not higher in dialysis patients than non-dialysis patients. The DRA puncture may be one of the option as puncture site even in dialysis patients.

scholarly journals The frequency of radial artery occlusion following cardiac catheterization with the use of transradial pneumatic compression band

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Kashif Ali Hashmi ◽  
Zahid Iqbal ◽  
Atif Ali Hashmi ◽  
Maira Shoaib ◽  
Muhammad Irfan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Radial Artery ◽  
Cardiac Catheterization ◽  
Age Groups ◽  
Vascular Complications ◽  
Artery Occlusion ◽  
Study Cohort ◽  
Coronary Catheterization ◽  
Significant Difference ◽  
Radial Artery Occlusion

Abstract Objectives Radial artery occlusion is a silent complication of a transradial approach to cardiac catheterization that may complicate subsequent transradial procedures in patients undergoing cardiac catheterization. A transradial band reduces vascular complications and provides brisk, powerful and effective haemostasis. The purpose of this study was to assess the frequency of radial artery occlusion in 180 patients undergoing transradial coronary catheterization. Results The median age of the study cohort was 58 years. Radial artery occlusion was found in 14 (7.8%) patients. When stratifying by age group and sex, there was no significant difference in radial artery occlusion between age groups and sex. It was likewise found that comorbidities such as diabetes mellitus, hypertension and smoking, increased the risk of radial artery occlusion however this was observed to be significant only for diabetes mellitus. We therefore conclude that a transradial pneumatic pressure band is an extremely helpful and safe strategy to prevent radial artery occlusion.

Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center Experience

Cardiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Lianna Xie ◽  
Xianjing Wei ◽  
Zezhou Xie ◽  
Shengying Jia ◽  
Siwei Xu ◽  
...  
Keyword(s):  
Radial Artery ◽  
Interventional Procedure ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Artery Cannulation ◽  
St Segment Elevation ◽  
Radial Access ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

<b><i>Objective:</i></b> Asymptomatic radial artery occlusion remains the most common complication in transradial coronary interventional procedure. To prevent radial artery occlusion, distal transradial access (dTRA) has been suggested recently. In this article, we aim to describe our experience and to assess feasibility and safety of this new access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI). <b><i>Methods:</i></b> We retrospective analyzed 1,063 consecutive patients who were assigned to undergo CAG or procedural PCI through dTRA between 1 January 2018 and 31 December 2019 at Affiliated Zhongshan Hospital of Dalian University. The size of radial sheath used was 5 or 6 French. The sheath was removed at procedure termination, and hemostasis was obtained by compression bandage with gauze. The success rate of dTRA access defined by successful radial artery cannulation on the first dTRA side attempted, the cause of access failure, the hemostasis duration, the incidence of post-catheterization radial artery occlusion, and the other access-related complications including hematoma of forearm and thumb numbness were assessed. <b><i>Results:</i></b> Radial artery cannulation via dTRA was successful in 953 of 1,063 patients with a success rate of 89.7%. Mean age of successful cases was 64.6 ± 11.2 years (26–94 years) with 339 (35.6%) women. A total of 363 (38.1%) cases were PCI. Among them, 95 cases (10%) underwent urgent PCI, including primary PCI in 64 patients with ST-segment elevation myocardial infarction and immediate PCI (&#x3c;2 h from hospital admission) in 31 patients with very high-risk non-ST-segment elevation acute coronary syndrome. A total of 269 (28.2%) cases were via left dTRA. The 6 French sheath was used in 602 (63.2%) cases. Hemostasis was obtained within 2 h in 853 (89.5%) patients. There were 110 (10.3%) procedural failures: 59 (5.6%) cases of artery puncture failure, 49 (4.9%) cases of guide wire insertion failure, and 2 (0.2%) cases of sheath insertion failure. Complications potentially related to distal radial access included radial artery occlusion at the access site (13 cases, 1.4%), forearm radial artery occlusion (4 cases, 0.4%), hematoma of forearm (5 cases, 0.5%), and transient thumb numbness (2 cases, 0.2%). <b><i>Conclusion:</i></b> dTRA is a feasible and safe access and can be used as a rational alternative to traditional radial access for routine coronary interventional procedure.

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