scholarly journals Transradial Access: A Comprehensive Review

2021 ◽  
Vol 4 ◽  
Author(s):  
Shawn Hobby ◽  
Maxwell Stroebel ◽  
Ricardo Yamada ◽  
Thor Johnson ◽  
Andre Uflacker ◽  
...  
Keyword(s):  
Radial Artery ◽  
Lower Cost ◽  
Artery Occlusion ◽  
Patient Comfort ◽  
Complication Rates ◽  
Femoral Access ◽  
Transradial Access ◽  
Lower Complication ◽  
Anatomic Variants ◽  
Left Radial Artery

Transradial access (TRA) via the left radial artery is an alternative to traditional transfemoral access for catheter-based procedures that is becoming increasingly more relevant in all types of arterial vascular interventions. First investigated in the realm of cardiology, TRA has been proven to provide many benefits (such as lower complication rates, lower cost, and improved patient comfort during and after the procedure) when compared with traditional femoral access while maintaining efficacy. This article provides an in-depth summary of the technical aspects of radial access while incorporating more recent data to explain patient preference for TRA, and the ways that TRA can improve peri-procedure workflow and compensation. It also describes potential complications, such as radial artery spasm, difficult anatomic variants and radial artery occlusion, and then gives techniques for mitigating and treating these complications. The article explains why TRA has become an important option for vascular and interventional radiology physicians, and why it is likely that this will continue to grow in relevance.

scholarly journals Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

2019 ◽  
Vol 11 (7) ◽  
pp. 710-713 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Samir Sur ◽  
David J McCarthy ◽  
Brian Snelling ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Hospital Costs ◽  
Artery Occlusion ◽  
Patient Comfort ◽  
Complication Rates ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Access Site Complication ◽  
Patient Demographics

BackgroundThe transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve.ObjectiveTo report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA.MethodsA retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded.Results85 patients were identified with an average age of 53.8 years (range 18–82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications.ConclusiondTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.

scholarly journals Non-target digital ischemia in an ulnar artery distribution following transradial access: Case report and review of best practice techniques

2021 ◽  
pp. 112972982110008
Author(s):  
Patrick Kennedy ◽  
Darren Klass ◽  
John Chung
Keyword(s):  
Best Practice ◽  
Artery Aneurysm ◽  
Ulnar Artery ◽  
Complication Rates ◽  
Endovascular Interventions ◽  
Transradial Access ◽  
Digital Ischemia ◽  
Aneurysm Embolization ◽  
Lower Complication ◽  
Access Complications

Transradial access is a safe approach for visceral endovascular interventions, with lower complication rates compared to transfemoral access. This report describes an unusual case of ulnar artery thrombosis following splenic artery aneurysm embolization via left transradial approach, resulting in non-target digital ischemia and eventual amputation of the ring and little finger distal phalanges. Technical considerations to reduce the incidence of access complications are also reviewed, along with practice modifications undertaken at our institution following this case to improve outcomes.

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

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.

P1814A novel method of transradial approach for left ventricular endomyocardial biopsy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M I N G Lan ◽  
Q I N G He
Keyword(s):  
Radial Artery ◽  
Endomyocardial Biopsy ◽  
Diagnostic Yield ◽  
Clinical Importance ◽  
Left Ventricular ◽  
Skin Dose ◽  
Complication Rates ◽  
Transradial Access ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Abstract Background Left ventricular endomyocardial biopsy (LV-EMB) may offer a superior diagnostic yield compared with right ventricular endomyocardial biopsy (RV-EMB) in conditions predominantly affecting the LV. Recently, transradial way is used for LV-EMB, and it has lower complication rates and has an advantage of immediate post-procedural ambulation compared with transfemoral technique. Previous reports of transradial LV-EMB need relatively complicated sheathless guiding catheter exchanging. Purpose We aimed at finding a novel and easier transradial method with a 6F sheath and a 6F guiding catheter. Methods and results In this manuscript, we described a method that allowed interventional cardiologists to obtain LV-EMB via transradial access with a 6F sheath and a 6F guiding catheter. This technique was successfully conducted in 25 consecutive patients at our institution. The transradial success rate was 100% (25 of 25). Mild or moderate radial artery spasm occurred in only 1 (4%) patient, but no severe radial spasm was observed. All the patients were performed coronary angiography and left ventricular angiogram according to the indication, and they were performed EMB through the same radial sheaths without sheathless guiding catheter exchanging. Heparin was administered to 100% of patients at a dose of 5000IU. Median fluoroscopy time was 13.45min. Median total skin dose was 1478mGy. Median area product was 15486 cGy·cm2. All biopsy samples were graded as excellent quality. Immediate patient mobilization could be achieved in all patients. Radial artery patency was confirmed by doppler ultrasonography 24 hours after the sheath removal. There were no major complications (pericardial tamponade, life-threatening arrhythmia, cerebrovascular accident or death). Transradial LV-EMB with a 6F sheath Conclusions The present article demonstrates a result of feasibility, safety and efficacy of a novel transradial access for LV-EMB using a 6F sheath and a 6F guiding catheter. This is of clinical importance since this new technique may overcome the currently existing methods, and may be regarded as an interventional “one stop shop” technique.

scholarly journals Randomized Comparison of Terumo® Coated Slender™ versus Terumo® Noncoated Traditional Sheath during Radial Angiography or Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Birthe Sindberg ◽  
Christel Gry Aagren Nielsen ◽  
Marianne Hestbjerg Poulsen ◽  
Martin Bøhme Rasmussen ◽  
Steen Carstensen ◽  
...  
Keyword(s):  
Radial Artery ◽  
Rating Scale ◽  
Coronary Intervention ◽  
Numeric Rating Scale ◽  
Artery Occlusion ◽  
Success Rates ◽  
Femoral Access ◽  
Procedural Success ◽  
And Gender ◽  
Sheath Insertion

Background. The transradial approach is generally associated with few complications. However, periprocedural pain is still a common issue, potentially related to sheath insertion and/or arterial spasm, and may result in conversion to femoral access. Radial artery occlusion (RAO) following the procedure is also a potential risk. We evaluate whether the design of the sheath has any impact on these variables. Methods. A total of 1,000 patients scheduled for radial CAG or PCI were randomized (1:1) to the use of a Slender or a Standard sheath during the procedure. Randomization was stratified according to chosen sheath size (5, 6, 7 French) and gender. A radial band was used to obtain hemostasis after the procedure, employing a rapid deflation technique. A reverse Barbeau test was performed to evaluate radial artery patency after removal of the radial band, and level of pain was assessed using a numeric rating scale (NRS). Results. Use of the Slender sheath was associated with less pain during sheath insertion (median NRS 1 versus 2, p=0.02), whereas no difference was observed in pain during the procedure, radial procedural success rates, use of analgesics and sedatives during the procedure, and radial artery patency following the procedure. Rate of RAO was 1.5% with no difference between groups. Conclusion. The use of the hydrophilic coated Slender sheath during radial CAG or PCI was associated with less pain during sheath insertion, whereas no difference in other endpoints was observed. A rapid deflation technique was associated with RAO of only 1.5%.

Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis

2017 ◽  
Vol 68 (3) ◽  
pp. 318-327 ◽  
Author(s):  
Avnesh S. Thakor ◽  
Mohammed T. Alshammari ◽  
David M. Liu ◽  
John Chung ◽  
Stephen G.F. Ho ◽  
...  
Keyword(s):  
Cost Savings ◽  
Artery Occlusion ◽  
Outcome Analysis ◽  
Technical Approach ◽  
Single Centre ◽  
Effective Technique ◽  
Femoral Access ◽  
Transradial Access ◽  
The Mean ◽  
Transradial Intervention

Purpose The study sought to describe a single centre's technical approach to transradial intervention and report on clinical outcomes and safety. Methods A total of 749 transradial access (TRA) procedures were performed at a single hospital in 562 patients (174 women and 388 men). Procedures included 445 bland embolizations or chemoembolizations of the liver, 88 uterine artery embolizations, and 148 procedures for Selective Internal Radiation Therapy (Y90), which included mapping and administration. The mean age of the patients was 62 years (range 27–96 years). Results Four cases (0.5%) required crossover to transfemoral (tortuous anatomy, inability to secure a stable position for embolization, vessel spasm and base catheter not being of a sufficient length). A single asymptomatic, short-segment radial artery occlusion occurred (0.3%), 3 patients (0.4%) developed small hematomas postprocedurally, and 2 patients (0.7%) had transient neurological pain, which was resolved within a week without treatment. It was found that 98% of patients who had a previous femoral access procedure would choose radial access for subsequent procedures. Conclusions Transradial access is a safe, effective technique, with a learning curve; however, this procedure has the potential to significantly improve departmental workflow and cost savings for the department and patient experience.

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.

Use of Walrus balloon-guide catheter through sheathless radial approach for mechanical thrombectomy of right middle cerebral artery occlusion

2021 ◽  
pp. neurintsurg-2021-017985
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Hamid H Rai ◽  
Andre Monteiro ◽  
Faisal Almayman ◽  
...  
Keyword(s):  
Radial Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Femoral Access ◽  
Content Type ◽  
Radial Approach ◽  
Guide Catheter ◽  
Ct Angiogram ◽  
History Of ◽  
Video Player

The literature demonstrates a favorable first pass effect with balloon-guide catheter (BGC) for mechanical thrombectomy. An 8F BGC is routinely used with femoral access. We present the first video report of 8F BGC advanced through the radial artery using a sheathless technique (video 1). An approximately 70-year-old patient presented with left-sided hemiplegia, neglect, and dysarthria. A CT angiogram demonstrated right M1 occlusion, and the patient underwent urgent mechanical thrombectomy. Radial approach was preferred owing to patient history of anticoagulation. A 6F Sim Select intermediate catheter was used to minimize the step off as the 8F BGC was advanced into the radial artery over an 035 exchange-length Advantage Glidewire. A skin nick over the Glidewire Advantage facilitated the introduction of the 8F BGC into the radial artery. Standard mechanical thrombectomy using a combination of stent retriever and aspiration catheter (Solumbra technique) was performed, and thrombolysis in cerebral infarction 3 recanalization was achieved after a single pass. The National Institutes of Health Scale score improved from 12 to 4, with mild left facial droop, dysarthria, and decreased speech fluency. The patient was discharged from the hospital on postoperative day 2. Ultrasound should be used for immediate assessment of radial artery size and conversion to femoral access without delay if the radial artery is less than 2.5 mm.Video 1

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