1
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Bo ST, Zhu J, He LX, Zhu XL. Transarterial chemoembolization for unresectable hepatocellular carcinoma: a comparative study between transradial and transfemoral approaches. Front Oncol 2025; 15:1553939. [PMID: 40196738 PMCID: PMC11974136 DOI: 10.3389/fonc.2025.1553939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 03/05/2025] [Indexed: 04/09/2025] Open
Abstract
Background While transarterial chemoembolization (TACE) has been performed using both the transfemoral approach (TFA) and the transradial approach (TRA) to date, the relative superiority of these techniques remains uncertain. This study aimed to evaluate the relative clinical efficacy, radiation exposure, and safety associated with TRA- and TFA-based TACE procedures in patients with inoperable hepatocellular carcinoma (HCC). Methods This study compared the relative outcomes of consecutive inoperable HCC patients who were treated via TFA- or TRA-based TACE between January 2020 and August 2024. Results This retrospective analysis included 83 HCC patients, of whom 41 and 42 respectively underwent TFA- and TRA-based TACE. Both of these approaches were associated with technical success rates of 100%. The mean TACE duration in the TRA group was significantly shorter than that in the TFA group (57.4 ± 23.5 vs. 73.5 ± 23.3 min, P = 0.002), whereas both groups exhibited a similar median fluoroscopy time (14 min vs. 13 min, P = 0.415) and radiation dose (159 Gy.cm2 vs. 160 Gy.cm2, P = 0.946). Two patients in each group experienced puncture site hematomas (4.9% vs. 4.8%, P = 1.000). While patients in the TFA group required ≥ 20 h of postoperative bed rest, the same was not true for patients in the TRA group. Conclusion TRA- and TFA-based TACE are both safe and feasible approaches to treating inoperable HCC patients. Relative to the TFA-based approach, the TRA-based approach entails a significantly shorter arterial compression time and requires less postoperative bed rest.
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Affiliation(s)
- Shun-Ting Bo
- Department of Interventional Radiology, The Third People's Hospital of Yancheng City, Yancheng, China
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Zhu
- Department of Interventional Radiology, The Third People's Hospital of Yancheng City, Yancheng, China
| | - Li-Xiao He
- Department of Day Care, Binzhou People’s Hospital, Binzhou, China
| | - Xiao-Li Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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2
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Tsukagoshi J, Bhuyan A, Secemsky EA, Shirasu T, Nakama T, Jujo K, Wiley J, Kuno T. Procedural Feasibility and Peri-procedural Outcomes of Peripheral Endovascular Therapy via Transradial versus Transfemoral Access: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2024; 68:605-616. [PMID: 39111535 DOI: 10.1016/j.ejvs.2024.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/30/2024] [Accepted: 07/31/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate the safety and feasibility of transradial access for peripheral vascular interventions. DATA SOURCES MEDLINE and Embase. REVIEW METHODS MEDLINE and Embase databases were searched to June 2023 to identify studies investigating the outcomes of lower extremity, carotid, and visceral artery vascular interventions via transradial vs. transfemoral access. The primary outcome was procedural failure rate. Secondary outcomes were total access site complications, minor and major bleeding, stroke, access vessel occlusion, procedure time, fluoroscopy time, and contrast volume. RESULTS Eight randomised controlled trials and 29 observational studies yielded a total of 70 882 patients treated via transradial (n = 2 616) vs. transfemoral access (n = 68 338). The overall failure rate was 2.3 ± 0.7%, and the transradial approach was associated with a statistically significantly higher procedural failure rate than the transfemoral approach (3.9 ± 0.7% vs. 1.0 ± 0.3%; odds ratio [OR] 3.07, 95% confidence interval [CI] 1.84 - 5.12; I2 = 32%; p < .001). Subgroup analysis showed the highest failure rate in lower extremity interventions with 12.4 ± 4.9% for transradial vs. 4.0 ± 1.2% for transfemoral access. Conversely, procedural complications were statistically significantly fewer with transradial access for total access site complications (OR 0.64, 95% CI 0.45 - 0.91; I2 = 36%; p = .010). Minor bleeding was statistically significantly less with the transradial approach (OR 0.52, 95% CI 0.31 - 0.86; I2 = 30%; p = .010), whereas major bleeding and stroke rates were similar. Transradial access had more access vessel occlusion than transfemoral access (1.9% ± 0.5% vs. < 0.1% ± 0.0%; p = .004), although most remained asymptomatic. Procedure time, fluoroscopy time, and contrast volume were all comparable. GRADE certainty was low to moderate in most outcomes. CONCLUSION The transradial approach was associated with a higher procedural failure rate. Total access site complications and minor bleeding were lower with the transradial approach, albeit with more frequent access vessel occlusion. Transradial access may be a feasible and safe approach; however, appropriate patient selection is imperative.
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Affiliation(s)
- Junji Tsukagoshi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. https://twitter.com/jt_TeamWADA
| | - Arijit Bhuyan
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Eric A Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA. https://twitter.com/EricSecemskyMD
| | - Takuro Shirasu
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Centre, Urayasu, Japan. https://twitter.com/tatsuya_nakama
| | - Kentaro Jujo
- Department of Cardiology, Saitama Medical University, Iruma, Japan. https://twitter.com/jujo85553842
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Los Angeles, CA, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Centre, Albert Einstein College of Medicine, New York, NY, USA; Department of Cardiology, Jacobi Medical Centre, Albert Einstein College of Medicine, New York, NY, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Worley L, Szekeres D, Akkipeddi SM, Schartz D, Sharma AK. Transradial versus transfemoral access for treatment of HCC: a systematic review and meta analysis. Clin Radiol 2024; 79:826-832. [PMID: 39174420 DOI: 10.1016/j.crad.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/14/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024]
Abstract
AIM Hepatic angiography procedures are essential in the treatment of hepatocellular carcinoma (HCC), with traditional transfemoral arterial (TFA) access being the traditional standard. Recently, transradial arterial (TRA) access has gained popularity, offering potential benefits. This study aims to conduct a systematic review and meta-analysis to compare TRA and TFA access in hepatic angiography oncologic procedures for HCC. The study investigates fluoroscopy time, radiation dose, patient preferences, and complications associated with each access method. MATERIAL AND METHODS A systematic review was performed using PRISMA guidelines, with 11 studies encompassing 2535 HCC procedures included. Statistical analysis was conducted using RevMan 5.4 software. Continuous outcomes were calculated as mean differences, and binary outcomes were measured as odds ratios. Patient preferences, procedural complications, and access site success rates were assessed. RESULTS The meta-analysis revealed that there were no significant differences in fluoroscopy time, radiation dose, or contrast dose between TRA and TFA. Access failure rates were similar for both methods. However, the odds of adverse events, excluding access failure, were significantly higher for TFA, while the overall rate of complications was comparable. Patients strongly preferred TRA over TFA due to reduced hospital stay and post-procedure discomfort. CONCLUSION This meta-analysis supports the use of TRA for hepatic angiography oncologic procedures for HCC with patient preferences in favor of TRA. Additional randomized clinical trials are encouraged to further evaluate the feasibility and benefits of both access sites.
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Affiliation(s)
- L Worley
- University of Rochester School of Medicine and Dentistry, USA.
| | - D Szekeres
- University of Rochester School of Medicine and Dentistry, USA.
| | - S M Akkipeddi
- University of Rochester School of Medicine and Dentistry, USA.
| | - D Schartz
- University of Rochester Medical Center, USA.
| | - A K Sharma
- University of Rochester Medical Center, USA.
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4
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Yang M, Jiang S, Wang Y, Meng X, Guo L, Zhang W, Zhou X, Yan Z, Li J, Dong W. Chinese expert consensus on transradial access in percutaneous peripheral interventions. J Interv Med 2023; 6:145-152. [PMID: 38312127 PMCID: PMC10831370 DOI: 10.1016/j.jimed.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 02/06/2024] Open
Abstract
Transradial access (TRA) is a safe and comfortable approach and the preferred access for percutaneous coronary intervention. However, TRA is not widely used for peripheral interventions. Currently, there is a lack of data on patient selection, appropriate medical devices, complication prevention, and TRA adoption. Therefore, the Chinese Society of Interventional Oncology of the China Anti-Cancer Association organized nationwide experts to establish a Working Group of China Expert Consensus on TRA in percutaneous peripheral interventions in 2022, and jointly formulated this consensus to better promote the application of TRA in peripheral interventions to guide clinicians on patient selection, technical recommendations, and physician training. This consensus mainly focuses on the current situation, advantages and limitations of TRA in peripheral interventions, anatomical characteristics of the radial artery, patient selection, technical aspects, prevention and management of complications, radiation dose, and learning curve. A consensus was reached through a literature evaluation and by referring to the opinions of the expert group.
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Affiliation(s)
- Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Sen Jiang
- Department of Radiology, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Yangpu District, Shanghai, China
| | - Yanli Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, China
| | - Xiaoxi Meng
- Department of Interventional Radiology, Shanghai Changzheng Hospital, 415 Feng Yang Road, Huangpu District, Shanghai, China
| | - Liwen Guo
- Department of Interventional Radiology, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Jiarui Li
- Department of Interventional Radiology, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, China
| | - Weihua Dong
- Department of Interventional Radiology, Shanghai Changzheng Hospital, 415 Feng Yang Road, Huangpu District, Shanghai, China
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5
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Ma X, Chen H, Luo X, Wang J, Zhou B, Liu X. The clinical application of transarterial embolization via radial artery in hemorrhagic diseases in obstetrics and gynecology. Front Med (Lausanne) 2023; 10:1273179. [PMID: 37928466 PMCID: PMC10621200 DOI: 10.3389/fmed.2023.1273179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose The present study aimed to explore the feasibility and safety of Transarterial embolization (TAE) in the treatment of obstetrics and gynecological hemorrhagic diseases transradial approach (TRA) compared to transfemoral approach (TFA). Methods This cohort study was conducted on patients with obstetrics and gynecology bleeding diseases from June 2021 to November 2022. Clinical characteristics of the patients were comparable between the two groups. The success rate of puncture and embolization, radiation dose, operation time, fluoroscopy time (FT), as well as complications of each patient were recorded and then retrospectively analyzed the data. The European Five-dimensional Health Scale (ED-5Q) and visual analog scale (VAS) were used to assess the quality of life (QOL) on the day of discharge and 30 days after surgery between the two groups. Results A total of 71 patients undergoing TAE were allocated to the TRA (n = 31) or TFA (n = 40) group in this study. Puncture and embolization were completed in all patients. Compared to the TFA group, the radiation dose of the TRA group (343.89 ± 108.81 mGy vs. 469.29 ± 198.66 mGy; p = 0.029) is significantly reduced. Minor complications occurred in only one patient (3.2%) in the TRA group. The surgery-related quality of life EQ-5D index score on the day of discharge in the TRA group (0.72 ± 0.12 vs. 0.65 ± 0.11; p = 0.017) was significantly higher than that in the TFA group, and the VAS score (2.55 ± 0.62 vs. 2.95 ± 0.85; p = 0.025) of catheter site discomfort was significantly lower in the TRA group were than in the TFA group, but no significant difference was observed in the QOL assessment at 30 days post-surgery. Conclusion Transradial approach TAE has comparable efficacy and safety to TFA TAE in treating obstetrics and gynecological bleeding diseases. This access can improve patient QOL without affecting surgical safety.
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Affiliation(s)
| | | | | | | | | | - Xi Liu
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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6
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Yeisley CD, Holuka JT, Voutsinas N, Noor A. Transradial Catheterization in the Prone Position: A Technique that Simplifies Complex Post-procedural Renal Intervention for Patients Undergoing Renal Angiography for Nephrostomy-Related Hemorrhage. Cardiovasc Intervent Radiol 2023; 46:1295-1297. [PMID: 37550586 DOI: 10.1007/s00270-023-03511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Christopher D Yeisley
- Division of Interventional Radiology, Department of Radiology, Northwell Health, New Hyde Park, USA.
| | | | - Nicholas Voutsinas
- Division of Interventional Radiology, Department of Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Amir Noor
- Division of Interventional Radiology, Department of Radiology, New York University School of Medicine, New York, USA
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7
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Jiang F, Fan WL, Zheng W, Wu X, Hu H. Distal radial artery access is a safe and feasible technique in the anatomical snuffbox for visceral intervention. Medicine (Baltimore) 2023; 102:e33987. [PMID: 37327275 PMCID: PMC10270534 DOI: 10.1097/md.0000000000033987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
Regarding the site of arterial access during the intervention, transracial intervention can reduce the risk of bleeding and vessel-related complications as well as improve patient comfort. Importantly, the distal radial artery (DRA) approach may reduce the incidence of radial artery occlusion and digital ischemia, but the feasibility and safety of DRA in performing subdiaphragmatic vascular interventions remain unclear. From January 2018 to December 2019, 106 patients were admitted to our department for visceral angiography and intervention by left distal radial artery accessing in an anatomical snuffbox. In total, 152 times of vascular interventions were performed during this period. Patients demographics, procedure details, technical success, and access site-related complications were recorded and evaluated. The mean age was 58.9 (range 22-86) years. Males accounted for 80.2%. Thirty-five patients (33%) had 2 or more procedures via the DRA approach. Technical success was achieved for 96.1% of procedures (146 cases) and 3.9% of cases failed to perform the intended procedure via the DRA approach (6 cases). The 4-Fr sheath was used in 86.8% of cases, and the 5 Fr sheath was used in the rest of the 13.2% of procedures. The rate of asymptomatic radial artery occlusion was 5.7% (6 of 106 patients). No patient suffered from distal limb ischemia after a long-time follow-up. Eight patients suffered postoperative local pain, transient numbness, or local bruised in the anatomical snuffbox without major complications. Patients with postoperative complications recovered quickly by using nonsteroidal anti-inflammatory drugs or without further treatment. Left distal radial artery access is safe and feasible as a new technique for visceral angiography and intervention.
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Affiliation(s)
- Feng Jiang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wen-Long Fan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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8
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Zakeri SA, Mohammad F, Nowakowska M, Kakani Ebir N, Ananthakrishnan G. A Single-Centre Retrospective Analysis of Radial Versus Femoral Prostate Artery Embolization. Vasc Endovascular Surg 2023; 57:123-128. [PMID: 36189716 DOI: 10.1177/15385744221131175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose: To determine whether route of access, transradial or transfemoral, leads to any discernible differences in patient radiation or contrast medium exposure as well as procedure time in elective prostate artery embolization (PAE).Methods: This retrospective study included sixty patients in total: n = 30 in the radial PAE group, and n = 30 in the femoral PAE group. All procedures were performed in a single angiography suite between May 2018 and January 2021, using a standard kit for each type of vascular access, the same microcatheter/wire combination and embolic agent to super-selectively target and embolize one or both prostate arteries. Outcome measures included dose area product (DAP, µGym2), air kerma (mGy), fluoroscopy time (mins), procedure time (mins) and volume of contrast medium used (mL). Adverse events were also recorded.Results: The radial and femoral groups were matched for age (73.2 ± 7.5 vs 71.3 ± 10.14, P = .41) and body mass index (27.53 ± 5.08 vs 26.41 ± 3.93, P = .38).No significant difference in dose area product, air kerma, fluoroscopy time, procedure time or volume of contrast medium used was found between radial and femoral PAE. No adverse events occurred in either group.Conclusion: Radial PAE is safe and comparable to femoral PAE with respect to patient radiation exposure, contrast medium usage, and procedure duration. Radial access is a useful skill to add to the armament of the interventional radiologist in elective PAE.
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Affiliation(s)
- Simon Arian Zakeri
- Department of Vascular Interventional Radiology, 105551Manchester Royal Infirmary, UK
| | - Fahad Mohammad
- Department of Vascular Interventional Radiology, 105551Manchester Royal Infirmary, UK
| | - Magdalena Nowakowska
- Centre for Primary Care and Health Services Research; Manchester Academic Health Science Centre (MAHSC), 5292The University of Manchester, UK
| | - Nirmal Kakani Ebir
- Department of Vascular Interventional Radiology, 105551Manchester Royal Infirmary, UK
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9
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Smith JC. Feasibility of Transtibial Access for Uterine Artery Embolization. J Vasc Interv Radiol 2022; 33:554-557. [PMID: 35489785 DOI: 10.1016/j.jvir.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/04/2022] [Accepted: 02/06/2022] [Indexed: 10/18/2022] Open
Abstract
Ten women with a mean body mass index of 31.5 kg/m2 and symptomatic uterine pathology underwent uterine artery embolization (UAE) via transtibial access (TTA). Nine out of 10 UAEs were successfully performed via TTA, with 2 minor adverse events. Outpatients with leiomyomas had stable to improved symptoms at follow-up; hospitalized patients with abnormal uterine bleeding from malignant tumors or arteriovenous malformations were discharged shortly after UAE with the cessation of hemorrhage. TTA is a feasible alternative for UAE for patients with obesity, diminutive radial arteries, or atherosclerosis that may confer an added risk of rare neurologic adverse events from transradial access.
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Affiliation(s)
- Jason C Smith
- Division of Interventional Radiology, Department of Radiology, Loma Linda University Health, Loma Linda, California.
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10
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Radiation Eye Dose for Physicians in CT Fluoroscopy-Guided Biopsy. Tomography 2022; 8:438-446. [PMID: 35202201 PMCID: PMC8878526 DOI: 10.3390/tomography8010036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 01/29/2023] Open
Abstract
It is important to evaluate the radiation eye dose (3 mm dose equivalent, Hp (3)) received by physicians during computed tomography fluoroscopy (CTF)-guided biopsy, as physicians are close to the source of scattered radiation. In this study, we measured the radiation eye dose in Hp (3) received by one physician during CTF in a timeframe of 18 months using a direct eye dosimeter, the DOSIRISTM. The physician placed eye dosimeters above and under their lead (Pb) eyeglasses. We recorded the occupational radiation dose received using a neck dosimeter, gathered CT dose-related parameters (e.g., CT-fluoroscopic acquisition number, CT-fluoroscopic time, and CT-fluoroscopic mAs), and performed a total of 95 procedures during CTF-guided biopsies. We also estimated the eye dose (Hp (3)) received using neck personal dosimeters and CT dose-related parameters. The physician eye doses (right and left side) received in terms of Hp (3) without the use of Pb eyeglasses for 18 months were 2.25 and 2.06 mSv, respectively. The protective effect of the Pb eyeglasses (0.5 mm Pb) on the right and left sides during CTF procedures was 27.8 and 37.5%, respectively. This study proved the existence of significant correlations between the eye and neck dose measurement (right and left sides, R2 = 0.82 and R2 = 0.55, respectively) in physicians. In addition, we found significant correlations between CT-related parameters, such as CT-fluoroscopy mAs, and radiation eye doses (right and left sides, R2 = 0.50 and R2 = 0.52, respectively). The eye dose of Hp (3) received in CTF was underestimated when evaluated using neck dosimeters. Therefore, we suggest that the physician involved in CTF use a direct eye dosimeter such as the DOSIRIS for the accurate evaluation of their eye lens dose.
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11
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Society of Interventional Radiology Quality Improvement Standards on Radial Artery Access. J Vasc Interv Radiol 2021; 32:761.e1-761.e21. [PMID: 33933252 DOI: 10.1016/j.jvir.2020.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
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12
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Inaba Y, Hitachi S, Watanuki M, Chida K. Occupational Radiation Dose to Eye Lenses in CT-Guided Interventions Using MDCT-Fluoroscopy. Diagnostics (Basel) 2021; 11:diagnostics11040646. [PMID: 33918341 PMCID: PMC8065869 DOI: 10.3390/diagnostics11040646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
In computed tomography (CT)-guided interventions (CTIs), physicians are close to a source of scattered radiation. The physician and staff are at high risk of radiation-induced injury (cataracts). Thus, dose-reducing measures for physicians are important. However, few previous reports have examined radiation doses to physicians in CTIs. This study evaluated the radiation dose to the physician and medical staff using multi detector (MD)CT-fluoroscopy, and attempted to understand radiation-protection and -reduction methods. The procedures were performed using an interventional radiology (IVR)-CT system. We measured the occupational radiation dose (physician and nurse) using a personal dosimeter in real-time, gathered CT-related parameters (fluoroscopy time, mAs, CT dose index (CTDI), and dose length product (DLP)), and performed consecutive 232 procedures in CT-guided biopsy. Physician doses (eye lens, neck, and hand; μSv, average ± SD) in our CTIs were 39.1 ± 36.3, 23.1 ± 23.7, and 28.6 ± 31.0, respectively. Nurse doses (neck and chest) were lower (2.3 ± 5.0 and 2.4 ± 4.4, respectively) than the physician doses. There were significant correlations between the physician doses (eye and neck) and related factors, such as CT-fluoroscopy mAs (eye dose: r = 0.90 and neck dose: r = 0.83). We need to understand the importance of reducing/optimizing the dose to the physician and medical staff in CTIs. Our study suggests that physician and staff doses were not significant when the procedures were performed with the appropriate radiation protection and low-dose techniques.
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Affiliation(s)
- Yohei Inaba
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan;
- Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba, Sendai, Miyagi 980-0845, Japan
- Correspondence: ; Tel.: +81-22-717-8683
| | - Shin Hitachi
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan;
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan;
| | - Koichi Chida
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan;
- Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba, Sendai, Miyagi 980-0845, Japan
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Contegiacomo A, Cina A, Di Stasi C, Barone M, Scrofani AR, Barbieri P, Punzi E, Manfredi R. Uterine Myomas: Endovascular Treatment. Semin Ultrasound CT MR 2021; 42:13-24. [PMID: 33541585 DOI: 10.1053/j.sult.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine fibroids embolization is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication to treatment is usually the presence of symptomatic uterine fibroids. In this review, a systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was conducted, with a special focus on the indication to treatment, technique, procedural outcomes and pain control. All clinical trials published in English language, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered.
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Affiliation(s)
- Andrea Contegiacomo
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Alessandro Cina
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmine Di Stasi
- UOC Radiodiagnostica Ospedale SS. Annunziata, Presidio Ospedaliero Centrale ASL Taranto, Taranto, Italy
| | - Michele Barone
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Anna Rita Scrofani
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Pierluigi Barbieri
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Ernesto Punzi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
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14
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Himiniuc LM, Murarasu M, Toma B, Popovici R, Grigore AM, Scripcariu IS, Oancea M, Grigore M. Transradial Embolization, an Underused Type of Uterine Artery Embolization Approach: A Systematic Review. ACTA ACUST UNITED AC 2021; 57:medicina57020083. [PMID: 33498309 PMCID: PMC7909283 DOI: 10.3390/medicina57020083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The most utilized approach for the embolization of uterine arteries is the transfemoral path. However, the transradial approach (TRA) has been gaining popularity among cardiologic interventions in the last years but only few studies have shown its applicability in uterine myoma treatment. The objective of this paper is to assess the feasibility, safety and efficacy of TRA when compared with the transbrachial, transulnar or transfemoral approach (TFA) for uterine arteries embolization (UAE). Materials and methods: A systematic review of the literature that analyzes the TRA for UAE it was carried out, in order to assess its safety and effectiveness. It was systematically searched the literature (Google Scholar, PubMed/MEDLINE, Cochrane Library and Embase) using the words ''uterine artery embolization''/''uterine embolization'' and ''transradial''/''radial''. All the relevant papers published until March 2020 were retrieved and analyzed. Results: Ten studies were considered eligible for this topic. TRA is a comparable method with TFA for uterine artery embolization. Conclusions: These studies allowed us to conclude that TRA is as safe and efficient as TFA. Its advantages include few complications, shorter hospitalization period, and rapid mobilization but a steeper learning curve has the disadvantage of a longer learning curve compared to TFA. Yet, these findings are built on few reports and more research is needed.
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Affiliation(s)
- Loredana Maria Himiniuc
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
| | - Mara Murarasu
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
| | - Bogdan Toma
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
- Correspondence: (B.T.); (M.O.); Tel.: +40-746-054-647 (B.T.); +40-744-374-782 (M.O.)
| | - Razvan Popovici
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Ana-Maria Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Ioana-Sadiye Scripcariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Mihaela Oancea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Iuliu Hateganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (B.T.); (M.O.); Tel.: +40-746-054-647 (B.T.); +40-744-374-782 (M.O.)
| | - Mihaela Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
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15
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Chu HH, Kim JW, Shin JH, Cho SB. Update on Transradial Access for Percutaneous Transcatheter Visceral Artery Embolization. Korean J Radiol 2020; 22:72-85. [PMID: 32901463 PMCID: PMC7772376 DOI: 10.3348/kjr.2020.0209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/29/2022] Open
Abstract
Transfemoral access (TFA) is a widely used first-line approach for most peripheral vascular interventions. Since its introduction in cardiologic and neurointerventional procedures, several advantages of transradial access (TRA) over TFA have been demonstrated, such as patient preference, lower complication rates, early ambulation, and shorter hospital stay. However, studies reporting the safety and efficacy of this approach for peripheral vascular interventions performed by interventional radiologists are relatively few. This review aimed to summarize the technique and clinical applications of TRA in percutaneous transcatheter visceral artery embolization and the management of complications.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
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16
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Left Distal Transradial Access (ldTRA): A Comparative Assessment of Conventional and Distal Radial Artery Size. Cardiovasc Intervent Radiol 2020; 43:850-857. [DOI: 10.1007/s00270-020-02485-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
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17
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Caputo RP. Editorial: Transradial Access - to the Heart of the Matter and More. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:227-229. [PMID: 32199666 DOI: 10.1016/j.carrev.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ronald P Caputo
- St. Joseph's Cardiovascular Specialists, 4939 Brittonfield Pkwy, Suite 202, East Syracuse, NY 13058.
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18
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Nonfemoral Arterial Hemostasis Following Percutaneous Intervention Using a Focused Compression Device. Cardiovasc Intervent Radiol 2020; 43:714-720. [PMID: 32043200 PMCID: PMC7241965 DOI: 10.1007/s00270-020-02431-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/30/2020] [Indexed: 11/12/2022]
Abstract
Purpose Upper extremity and tibiopedal arterial access are increasingly used
during endovascular therapies. Balloon compression hemostasis devices in these
anatomic locations have been described, but most utilize a compression surface
extending well beyond the puncture site. We report single-center experience with
an arterial puncture-focused compression device following upper extremity and
tibiopedal access. Patients and Methods A series of 249 focused compression hemostasis devices (VasoStat,
Forge Medical, Bethlehem, Pennsylvania, USA) were used in 209 patients following
lower extremity (n = 63) and upper extremity
(n = 186; radial: 90%) arterial access
procedures using 4–7 French sheaths. Demographic, operative, and follow-up data
were collected. Logistic regression was used to evaluate potential association
between patient/operative variables and time to hemostasis. Results Primary hemostasis was achieved in 97.2% (242/249) following sheath
removal; in 7 cases (2.8%) puncture site oozing occurred after initial device
removal and required reapplication. Secondary hemostasis was 100% (249/249). Seven
complications (2.8%) were recorded: 5 minor hematomas (2%) and 2 transient access
artery occlusions (0.8%). Mean time to hemostasis enabling device removal was
55 ± 28 min. Elevated body mass index (BMI) was not associated with increased time
to hemostasis (p = 0.31). Accessed artery,
sheath size, and heparin dose were also not associated with time to hemostasis
(p = 0.64; p = 0.74; p = 0.75,
respectively). Conclusions The focused compression hemostasis device enabled rapid hemostasis
with a low complication rate. Time to hemostasis was independent of BMI, access
site, sheath size, or heparin dose.
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19
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Nakhaei M, Mojtahedi A, Faintuch S, Sarwar A, Brook OR. Transradial and Transfemoral Uterine Fibroid Embolization Comparative Study: Technical and Clinical Outcomes. J Vasc Interv Radiol 2019; 31:123-129. [PMID: 31771890 DOI: 10.1016/j.jvir.2019.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare clinical and technical outcomes of transradial (TRA) uterine artery embolization (UAE) with those of the transfemoral (TFA) approach. MATERIALS AND METHODS Consecutive patients who underwent UAE with TRA and TFA in an academic hospital between May 2014 and June 2018 were included in this study. The ability to perform the procedure as planned, complication rates, and reduction in uterine volume, fibroid enhancement, and symptomatic improvement were compared using descriptive statistics, Student t-test, and chi-square test. RESULTS There were 91 patients in the TFA group and 91 patients in the TRA group, with 1 crossover to TFA due to vasospasm (1 of 91; 1%). The tallest patient in the TRA UAE group was 178 cm and 4 patients taller than 178 cm in the TFA UAE group. Larger particles (900-1,200 μm) were more often used in the TFA group than in the TRA group (P < .001). There were similar low rates of minor access site complications. In the TFA group (6 of 91, 7%), 5 patients had groin hematomas, and 2 patients had groin pain compared to the TRA group (5 of 91, 5%): in which 4 patients had transient focal occlusion of the radial artery and 1 patient had focal pain, all of which resolved with conservative management. There were similar rates of uterine volume reduction in 40% ± 17% in the TFA versus 36% ± 16% in the TRA group (P = .22) and no residual enhancement in 49 of 58 [84%] in the TFA group versus 66 of 77 [86%] in the TRA group (P = .84). There were similar reductions in modifying symptoms (60 of 64 [94%] in the TRA group; and 37 of 40 [93%] in the TFA group; P = NS) was noted at follow-up. CONCLUSIONS Transradial UAE in women up to 178 cm tall and transfemoral UAE have similar technical and clinical outcomes, with low rates of access site complications.
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Affiliation(s)
- Masoud Nakhaei
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Harvard Medical School, Boston, Massachusetts
| | - Alireza Mojtahedi
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Harvard Medical School, Boston, Massachusetts
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Harvard Medical School, Boston, Massachusetts
| | - Ammar Sarwar
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Harvard Medical School, Boston, Massachusetts
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Harvard Medical School, Boston, Massachusetts.
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20
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Matsumoto T, Hasebe T, Kamei S, Tomita K, Yamamoto S, Zakoji H, Yoshimatsu R, Kajiwara K, Karashima T, Yamagami T. Snuff box radial access in transcatheter arterial embolization for unruptured renal angiomyolipoma. MINIM INVASIV THER 2019; 30:27-32. [PMID: 31536429 DOI: 10.1080/13645706.2019.1665549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We report the first three cases in which the feasibility and safety of the left snuff box radial access in transcatheter arterial embolization (TAE) for unruptured renal angiomyolipoma (AML) were evaluated. MATERIAL AND METHODS Three patients with unruptured renal AMLs underwent TAE via the left snuff box radial artery. We retrospectively evaluated the characteristics of the AMLs, technical success rate, clinical success rate, and complications. Technical success and clinical success were defined as successful insertions of microballoon catheters selectively via the left distal radial artery into all intended arteries in a treatment session and shrinkage of tumor size as evaluated by CT or MRI after the procedure, respectively. RESULTS The median size of the renal AMLs was 49 mm. TAE was successfully performed in all cases and all feeding arteries were successfully selected with a microballoon catheter through the left snuff box radial artery. The median amount of the mixture of ethanol and Lipiodol was 1.8 mL. Tumor shrinkage was confirmed in all with a median follow-up period of 6 months. The clinical success rate was 100%. No major complications occurred. CONCLUSION The left snuff box access in TAE for an unruptured renal AML is safe and feasible.
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Affiliation(s)
- Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan
| | - Shota Yamamoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan
| | - Hidenori Zakoji
- Department of Urology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi University, Kochi Medical School, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi University, Kochi Medical School, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi University, Kochi Medical School, Kochi, Japan
| | - Takuji Yamagami
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Japan.,Department of Radiology, Kochi University, Kochi Medical School, Kochi, Japan
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21
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Du N, Yang MJ, Ma JQ, Luo JJ, Zhang ZH, Yu TZ, Zheng ZY, Zhang W, Yan ZP. Transradial access chemoembolization for hepatocellular carcinoma in comparation with transfemoral access. Transl Cancer Res 2019; 8:1795-1805. [PMID: 35116930 PMCID: PMC8799211 DOI: 10.21037/tcr.2019.08.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022]
Abstract
Background This study aimed to compare the safety and efficacy of transradial access (TRA) with transfemoral access (TFA) chemoembolization in treatment of hepatocellular carcinoma (HCC). Methods HCC patients who were late for curative treatment on initial diagnosis or HCC patients who had undergone one or several rounds of transarterial chemoembolization (TACE) were enrolled. The clinical and angiographic characteristics, the procedure related details, and the follow-up data from patients who underwent TRA and TFA were analyzed and compared. Results In total, 112 patients undergoing 160 TRA-TACE and 107 patients undergoing 163 TFA-TACE were included. The technical success rate of TRA was 95.0% and that of TFA was 98.8% (P=0.102). In the TFA-TACE group, 5.5% of cases suffered access site-related complications, including 6 with minor bleeding and 3 with severe bleeding or pseudoaneurysm. In the TRA-TACE group, 1.9% of cases underwent crossover to femoral access for selective cannulation failure. The rate of radial artery occlusion (RAO) was 2.7% (3 of 112 patients), and none of the RAO patients suffered paresthesia, pain at the site of occlusion, hand function loss or distal ischemia. Comparing patients with/without access site-related complications in the TFA-TACE group, there was a statistical difference in patient age and in the percentage of patient with a PT time >15 s (72.6% vs. 57.1%, P<0.001; 44.4% vs. 11.7%, P=0.022). Conclusions TRA is a safe and effective method for patients undergoing TACE. Compared with TFA, TRA may reduce the occurrence of access site-related bleeding and vascular complications. TRA-TACE may especially benefit older patients or those with a longer prothrombin time (PT).
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Affiliation(s)
- Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Min-Jie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Jing-Qin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Jian-Jun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Zi-Han Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tian-Zhu Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhi-Yuan Zheng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
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22
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Republished: Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note. J Neurointerv Surg 2019; 11:e4. [DOI: 10.1136/neurintsurg-2019-014834.rep] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 11/03/2022]
Abstract
Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.
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23
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Orru E, Tsang COA, Klostranec JM, Pereira VM. Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note. BMJ Case Rep 2019; 12:12/3/e014834. [PMID: 30936323 DOI: 10.1136/bcr-2019-014834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.
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Affiliation(s)
- Emanuele Orru
- Department of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Jesse M Klostranec
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
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