Outcome off Primary Coronary Angioplasty by Radial Route: Study on 100 Cases

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr. Dilip Ratnani ◽  
Dr. Rekha Ratnani
Keyword(s):  
Hospital Stay ◽  
Radial Artery ◽  
Bleeding Complications ◽  
Access Site ◽  
Transfemoral Approach ◽  
Artery Cannulation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Radial Access ◽  
Coronary Procedures

Recently radial artery is being used as a vascular access route for coronary procedures. Primary angioplasty with transfemoral procedure is associated with high access site bleeding complications due to use of potent antiplatelets and anticoagulants therefore radial access should be preferred if the operators are experienced and familiar with the technique. Methods: Total 100 pa‡…tients were included in the study in which procedure was performed by the trans radial route. All routine laboratory investigations were performed. Support of a temporary pacemaker was kept ready. All patients were prepared according to the Cardiac Catheterization Laboratory Standards. Radial artery cannulation was performed. Results: 100 patients were included in the study selected for radial route. Mean age of the patients who underwent primary CAI was 59±8.4. The most affected artery in the as shown angiography was Left anterior descending (58%) followed by Right coronary artery (41%). Least affected artery was left main (6%) and Ramus intermedius (6%). Mean of diseased vessels was 1.34 ± 1.25. Crossover from radial to femoral route was done on 5 patients of which 2 patients were having radial artery anomaly and in 3 patients arterial puncture was not successful. Mean hospital stay of the patients after procedure was 6.8 ± 2.1. Conclusion: transradial approach for coronary procedures is a safe technique and gives similar clinical results to transfemoral access. Complications at the radial access site are negligible. Length of hospital stay, time to mobilisation and cost all are reduced in the transfemoral approach.

Feasibility of repeat transradial access for neuroendovascular procedures

2019 ◽  
Vol 12 (4) ◽  
pp. 431-434 ◽  
Author(s):  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
Samir Sur ◽  
Dileep R Yavagal ◽  
Robert M Starke ◽  
...  
Keyword(s):  
Radial Artery ◽  
Artery Occlusion ◽  
Access Site ◽  
Transfemoral Approach ◽  
Radial Access ◽  
Artery Segment ◽  
Clinical Consequences ◽  
Radial Artery Occlusion ◽  
Neurointerventional Procedures ◽  
Repeat Procedures

IntroductionTransradial artery access (TRA) for cerebrovascular angiography is increasing due to decreased access site complications and overwhelming patient preference. While interventional cardiologists have reported up to 10 successive TRA procedures via the same radial access site, this is the first study examining successive use of the same artery for repeat procedures in neurointerventional procedures.1 MethodsWe reviewed our prospective institutional database for all patients who underwent a transradial neurointerventional procedure between 2015 and 2019. Index procedures were defined as procedures performed via TRA after which there was a second TRA procedure attempted. Reasons for conversion to a transfemoral approach (TFA) for subsequent procedures were identified.Results104 patients underwent 237 procedures (230 TRA, 7 TFA). 97 patients underwent ≥2 TRA procedures, 20 patients >3, four patients >4, three patients >5, and two patients >6 TRA procedures. The success rate was 94.7% (126/133) with 52% (66/126) of successive procedures performed via the same radial access site (snuffbox vs antebrachial) while the alternate radial artery segment was used for access in 48% (60/126) of subsequent procedures. There were seven (5.3%) cases requiring crossover to TFA, six cases for radial artery occlusion (RAO) and one for radial artery narrowing.ConclusionSuccessive TRA is both technically feasible and safe for neuroendovascular procedures in up to six procedures. The low failure rate (5.3%) was primarily due to RAO. Thus, even without clinical consequences, strategies to minimize RAO should be optimized for patients to continue to benefit from TRA in future procedures.

scholarly journals Ulnar Artery Access: A Nontraditional Access Site for Diagnostic Cerebral Angiography and Neurointervention: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Rimal H Dossani ◽  
Muhammad Waqas ◽  
Justin M Cappuzzo ◽  
Ashish Sonig ◽  
Faisal Almayman ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Video Recording ◽  
Ulnar Artery ◽  
Lateral Approach ◽  
Access Site ◽  
Transfemoral Approach ◽  
Radial Access ◽  
Institutional Review ◽  
Neurointerventional Procedures

Abstract Transfemoral access has long been the main access site for cerebral angiography and neurointerventional procedures. Radial access is accepted as an alternative to the traditional transfemoral approach. Ulnar access may be undertaken if the radial artery is occluded or small caliber, or when radial artery preservation is needed. The safety and feasibility of ulnar access for neuroangiographic procedures has been demonstrated.1-3 In this operative video, we demonstrate ulnar artery access in a patient in whom radial artery preservation was desired. We further elaborate on the technical nuances of this access. This nontraditional access site offers the same advantages as radial access, avoiding the need to switch to femoral artery access. A preoperative Allen's test is not necessary. Ultrasound imaging is used to aid in the identification and successful puncture of the ulnar artery. A medial to lateral approach for ulnar artery puncture is advised to avoid injury to the ulnar nerve. Careful application of wrist closure bands avoids hematoma accumulation.  The patient gave informed consent for the procedure and video recording. Institutional review board approval was deemed unnecessary.  Video. © University at Buffalo, May 2021. Used with permission.

scholarly journals Anomalous Medial Branch of Radial Artery: A Rare Variant

2016 ◽  
Vol 59 (3) ◽  
pp. 100-103 ◽  
Author(s):  
Surbhi Wadhwa ◽  
Vandana Tomar
Keyword(s):  
Radial Artery ◽  
Anatomical Variations ◽  
Medial Branch ◽  
Normal Pattern ◽  
Access Site ◽  
Capillary Vessel ◽  
Radial Forearm ◽  
Coronary Procedures ◽  
Technical Failures ◽  
Flexor Carpi Radialis Muscle

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.

Access-Site Complications of the Transfemoral Approach

2021 ◽  
pp. 123-128
Author(s):  
Stephanie H. Chen ◽  
Pascal M. Jabbour ◽  
Eric C. Peterson
Keyword(s):  
Minimally Invasive ◽  
Femoral Artery ◽  
Access Route ◽  
Access Site ◽  
Transfemoral Approach ◽  
Femoral Access ◽  
Hematoma Formation ◽  
Radial Access ◽  
Femoral Approach ◽  
Life Threatening

The radial access route has significantly lower complications compared to the femoral access route. Often users have become used to the femoral approach and its attendant complications but it is worth reviewing that despite its minimally invasive nature as opposed to open craniotomy, endovascular transfemoral access is certainly not without risk. These risks include life threatening retroperiotenal hematoma formation and local hematoma formation as well as limb threatening occlusion of the femoral artery, which is an end artery thus must be urgently revascularlized in the event of compromise. The complications of femoral access are reviewed as well as strategies for management.

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 Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Andrew Ertel ◽  
Jeffrey Nadelson ◽  
Adhir R. Shroff ◽  
Ranya Sweis ◽  
Dean Ferrera ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Cardiac Catheterization ◽  
Patient Comfort ◽  
Bleeding Complications ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Radiation Scatter ◽  
The Right ◽  
The Impact

Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom’s trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P<0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.

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