Distal transradial artery access for vascular access intervention

2020 ◽  
pp. 112972982097423
Author(s):  
Shingo Watanabe ◽  
Michio Usui
Keyword(s):  
Radial Artery ◽  
Vascular Access ◽  
Case Series ◽  
Treatment Method ◽  
Artery Occlusion ◽  
Hemorrhagic Complication ◽  
Dialysis Patients ◽  
Access Site ◽  
Contrast Volume ◽  
Average Contrast

Background: Vascular access intervention is a useful treatment method for maintaining arteriovenous fistula (AVF) in dialysis patients. The outflow vein is commonly used as the access site for vascular access intervention. In cases where it is difficult to puncture veins due to multiple lesions or poor AVF development, vascular access intervention is performed using the radial artery. However, it is difficult to perform a vascular access intervention with radial artery access to the AVF in the distal forearm. We reported the efficacy and safety of vascular access intervention with distal transradial artery access (dTRA). Case series: We have been conducting vascular access intervention with dTRA access since January 2019. We evaluated complications and procedure time for 12 cases of vascular access intervention with dTRA access performed from January to December 2019. The success rate of the procedure was 100% and no puncture hemorrhagic complication was observed in 12 cases performed at our institution. No radial artery occlusion was observed in 12 cases. The average fluoroscopy time was 11.5 min and the average contrast volume was 41 ml. Conclusion: dTRA for vascular access intervention has advantages over conventional radial artery access in terms of safety of the procedure and ease of hemostasis.

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.

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<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<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<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<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<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.

Abstract 14475: Successive Distal Transradial Approach for Coronary Catheterization in the Same Arm

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takeshi Yamada ◽  
Soichiro Washimi ◽  
yuki matsubara ◽  
Sho Hashimoto ◽  
Norimasa Taniguchi ◽  
...  
Keyword(s):  
Radial Artery ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Artery Occlusion ◽  
Access Site ◽  
Transradial Approach ◽  
Coronary Catheterization ◽  
Initial Procedure ◽  
Second Procedure ◽  
Distal Radial Artery

Background: The distal transradial approach (dTRA) for coronary catheterization is a newly introduced alternative to the conventional transradial approach. This study investigated how many times the same distal radial artery can be cannulated for coronary catheterization. Methods: A total of 1717 patients underwent 2406 coronary catheterization procedures between April 2018 and March 2020. The dTRA was used as the primary approach whenever feasible in this study period, and the dTRA was used for 1555 patients (90.6%) and 2129 procedures (88.5%). Patients who underwent repeated coronary catheterization after the initial procedure using dTRA were included in this study. The incidence of successive application of dTRA in the same arm and the reasons for access site conversion were investigated. Results: A total of 430 patients were included in this study; of these, in 10 patients, the distal radial artery was cannulated on both sides in the initial procedure. The patient group included 320 men (74.4%), and the mean age was 72.2 ± 10.8 years. A 4-, 5-, or 6-French sheath or sheathless system was used in the initial procedure. A maximum of four successive coronary catheterization procedures, including the initial procedure, were carried out. The second procedure involved the distal radial artery on the same side in 394 cases (89.5%), and the fourth dTRA procedure was possible in 81.7% of the cases. Access site conversion during the follow-up procedure, which was observed in 57 cases, was attributed to radial artery occlusion (17.5%), narrowing of the distal radial artery (33.4%), tortuous route of the right upper limb approach (15.8%), and strategic reasons, such as aortography or coronary bypass graft angiography (15.8%). Conclusions: The dTRA was successfully applied in the same arm in 89.5% of the cases in the second procedure and 81.7% in the fourth coronary catheterization procedure.

Transradial intraoperative cerebral angiography: a multicenter case series and technical report

2019 ◽  
Vol 12 (2) ◽  
pp. 170-175
Author(s):  
Joshua W Osbun ◽  
Bhuvic Patel ◽  
Michael R Levitt ◽  
Alexander T Yahanda ◽  
Amar Shah ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Carotid Arteries ◽  
Case Series ◽  
Patient Positioning ◽  
Interventional Cardiology ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Access Site Complication

BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

Transulnar approach as an alternative to transradial approach in non-coronary intervention: safety, feasibility and technical factors

2017 ◽  
Vol 18 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Adam Zybulewski ◽  
Martin Edwards ◽  
Edward Kim ◽  
Francis S. Nowakowski ◽  
Rahul Patel ◽  
...  
Keyword(s):  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Effective Alternative ◽  
Bleeding Complications ◽  
Technical Success ◽  
Internal Radiation ◽  
Access Site ◽  
Technical Factors ◽  
Liver Embolization

Purpose Transulnar access (TUA) has been shown to be an effective alternative to transradial access (TRA) for coronary intervention. This study evaluates the safety and efficacy of TUA in patients undergoing visceral interventions in the setting of contraindication to TRA. Materials and Methods Patients who underwent visceral interventions via ulnar approach were included in the study. Outcome variables include technical success, access site and bleeding complications. Results From May 2014 to September 2016, TUA was attempted 17 times in 14 patients (mean age: 60 years; range: 27 to 81 years) for whom TRA was planned for visceral intervention, but contraindicated. Contraindication to TRA included Barbeau D waveform (n = 3), radial artery diameter <2 mm (n = 8), known radial loop (n = 2), high takeoff of the radial artery (n = 2), prior radial artery occlusion (RAO) (n = 1), and radiocephalic arteriovenous fistula (n = 1). Interventions included selective internal radiation therapy (SIRT) (n = 4), SIRT mapping (n = 2), chemoembolization (n = 6), renal embolization (n = 1) and bland liver embolization (n = 4). Technical success was achieved in 94.1% (16/17 cases) with the single failure attributed to an inability to cannulate the target vessel due to vessel tortuosity, requiring ipsilateral femoral crossover. There were no major access site or bleeding complications. Minor adverse events include two access site hematomas, which were successfully treated with conservative management. Conclusions TUA for visceral interventions is a safe and effective alternative to femoral approach when TRA is contraindicated.

Sheathless guiding catheter versus “slender” sheath/guiding catheter combination in acute coronary syndrome: a propensity-matched analysis of two downsized devices

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Isawa ◽  
K Horie ◽  
T Honda
Keyword(s):  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Coronary Syndrome ◽  
Radial Artery Occlusion ◽  
Transradial Pci ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Abstract Purpose We investigated the differences between a sheathless guiding catheter and a Glidesheath slender/guiding catheter combination regarding access-site complications in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods We enrolled consecutive 1108 patients undergoing transradial primary PCI for ACS at our hospital using either a 7.5-Fr sheathless guiding catheter (Sheathless group) or a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group); 1:1 propensity score matching was performed, and 718 subjects (359 in each group) were included in the propensity-matched sample. Results Compared with the Sheathless group, the Glidesheath group had significantly less frequent ultrasound-diagnosed radial artery occlusion at 30 days (Sheathless: 4.7% vs. Glidesheath: 1.4%, p=0.015). No significant differences were observed in severe radial spasm (Sheathless: 1.4% vs. Glidesheath: 2.0%, p=0.77) or access-site bleeding (Sheathless: 9.8% vs. Glidesheath: 8.6%, p=0.70). Conclusion Thus, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is clearly more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of radial artery occlusion in transradial PCI for ACS. “Sheathless” vs. “Glidesheath slender” Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document