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Yeh SD, Weng YS, Lin CY. Prostate Artery Embolization via Distal Transradial Artery Access in a 100-Year-Old Patient. J Pers Med 2023; 14:11. [PMID: 38276225 PMCID: PMC10817478 DOI: 10.3390/jpm14010011] [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: 11/06/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Benign prostatic obstruction (BPH) is a common disease in males and surgical treatment is the gold standard for this symptomatic disease. Prostate artery embolization (PAE) is one of the emerging therapies which aims to minimize the lower urinary tract symptoms (LUTS) of BPH and the volume of enlarged prostates. We reported here a case of 100-year-old man with 90 cm3 prostate and severe symptoms secondary to BPH, who underwent a successful PAE through distal transradial access without any complications. The patient was satisfied with this treatment and no symptoms recurred after PAE. This demonstrated that PAE was a safe and effective treatment for BPH and was recommended for elderly/non-surgical candidates.
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Affiliation(s)
- Shauh-Der Yeh
- Department of Urology, Prostate Center of Excellence and Cancer Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yu-Shiou Weng
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chun-Yu Lin
- Department of Radiology, Yonghe Cardinal Tien Hospital, New Taipei City 23445, Taiwan
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Eesa M, Mitha AP, Lewkonia P. Distal transradial access for targeted spinal angiography and embolization. Interv Neuroradiol 2023; 29:498-503. [PMID: 35484816 PMCID: PMC10549704 DOI: 10.1177/15910199221097489] [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: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of access through the femoral artery with the use of suitably shaped catheters for selective catheterization of the spinal segmental vasculature. The purpose of our study was to evaluate the safety and feasibility of distal transradial access through the "anatomical snuffbox" for targeted spinal angiography, for the investigation and treatment of selected spinal lesions. METHODS A retrospective review of patients who underwent transradial spinal angiography and embolization was performed from August 2019 to January 2022. A total of eight patients were identified, who underwent targeted spinal angiography through distal transradial access. Outcome measures were documented in a tabular manner. RESULTS Radial access was successful in all patients. Seven patients had vascular tumors of the spinal column and underwent tumor embolization followed by segmental artery occlusion prior to surgery. One patient had a spinal dural AV fistula that could not be embolized due to feeding vessel tortuosity and eventually went on to have a laminectomy. Mean fluoroscopy time was 31.4 min. There were no access site hemorrhagic complications. One patient experienced transient mild hand numbness during the period of hemostasis with the vascular compression device that resolved completely within 24 h. CONCLUSIONS Distal transradial access is a feasible and safe option for targeted spinal angiography and treatment in selected patients.
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Affiliation(s)
- Muneer Eesa
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Alim P Mitha
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Peter Lewkonia
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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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: 0] [Impact Index Per Article: 0] [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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4
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Luo YG, Zhang XW, Tsauo JW, Li Y, Li JG, Peng Q, Li YW, Sun W, Zhao H, Li X. Modified Patent Hemostasis Strategy Based on the Platelet Counts for Transradial Access Chemoembolization in Patients with Hepatocellular Carcinoma: A Prospective Single-Center Study. J Hepatocell Carcinoma 2023; 10:687-695. [PMID: 37113465 PMCID: PMC10128083 DOI: 10.2147/jhc.s410952] [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: 03/03/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Objective This study aimed to investigate the shortest compression time to achieve hemostasis and the optimal hemostasis strategy in patients treated with transradial access chemoembolization (TRA-TACE). Methods From October 2019 to October 2021, 119 consecutive patients with hepatocellular carcinoma (HCC) who underwent 134 sessions of TRA-TACE were included in this prospective single-center study. The compression time was measured by decompressing the device for 30 min, and thereafter, every 10 min after the procedure until complete hemostasis was achieved. Results Technical success was achieved for all TRA procedures. None of the patients experienced major TRA-related adverse events. Minor adverse events occurred in 7.5% of the patients. The mean compression time was 31.8 ± 5.0 min. Factors that may impact hemostasis were analyzed by univariate and multivariate analyses, and a platelet count < 100×109 /L (p = 0.016, odds ratio = 3.942) was found to be an independent factor that could predict the failure to achieve hemostasis within 30 min. For patients with a platelet count < 100×109 /L, the compression time required to achieve hemostasis was 60 min. For patients with a platelet count ≥ 100×109 /L, the compression time required to achieve hemostasis was 40 min. Conclusion To achieve hemostasis in patients with HCC treated with TRA-TACE, compression for 60 min is sufficient for those with a platelet count < 100×109 /L, and compression for 40 min is sufficient for those with a platelet count ≥ 100×109 /L.
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Affiliation(s)
- Yin-Gen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiao-Wu Zhang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiay-Wei Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ying Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jin-Gui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qing Peng
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ya-Wei Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Sun
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - He Zhao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Xiao Li; He Zhao, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Tel/Fax +86 010 8778 8502, Email ;
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Amouyal G, Tournier L, de Margerie-Mellon C, Bouda D, Pachev A, Assouline J, de Bazelaire C, Marques F, Le Strat S, Desgrandchamps F, De Kerviler E. Feasibility of Outpatient Transradial Prostatic Artery Embolization and Safety of a Shortened Deflation Protocol for Hemostasis. J Pers Med 2022; 12:jpm12071138. [PMID: 35887635 PMCID: PMC9316516 DOI: 10.3390/jpm12071138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: to evaluate the safety and feasibility of a shorter time to hemostasis applied to outpatient transradial (TR) Prostatic Artery Embolization (PAE). Methods: a retrospective bi-institutional study was conducted between July 2018 and April 2022 on 300 patients treated by outpatient TR PAE. Indications included lower urinary tract symptoms, acute urinary retention, and hematuria. Mean patient height was 176 ± 6.3 (158–192) cm. The primary endpoint was safety of a 45 min deflation protocol for hemostasis. The secondary endpoint was the feasibility of PAE using TR access. Results: technical success was 98.7% (296/300). There was one failure due to patient height. Mean DAP/fluoroscopy times were 16,225 ± 12,126.3 (2959–81,608) μGy·m2/35 ± 14.7 (11–97) min, and mean time to discharge was 80 ± 6 (75–90) min. All access site and embolization-related adverse events were minor. Mild hematoma occurred in 10% (30/300), radial artery occlusion (RAO) in 10/300 (3.3%) cases, and history of smoking was a predictor for RAO. There was no major event. Conclusion: the safety of TR PAE using a 45 min time to hemostasis was confirmed, and TR PAE is feasible in most cases. Radial artery occlusion was still observed and may be favored by smoking.
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Affiliation(s)
- Gregory Amouyal
- Hôpital Privé Geoffroy Saint-Hilaire—Ramsay Santé, 75005 Paris, France; (F.M.); (S.L.S.)
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Correspondence: ; Tel.: +33-670132138
| | - Louis Tournier
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Constance de Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Damien Bouda
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Atanas Pachev
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Jessica Assouline
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Cédric de Bazelaire
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Florent Marques
- Hôpital Privé Geoffroy Saint-Hilaire—Ramsay Santé, 75005 Paris, France; (F.M.); (S.L.S.)
| | - Solenne Le Strat
- Hôpital Privé Geoffroy Saint-Hilaire—Ramsay Santé, 75005 Paris, France; (F.M.); (S.L.S.)
| | - François Desgrandchamps
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
- Urology Department, Hôpital Saint-Louis, 75010 Paris, France
- SRHI/CEA—Institut de Recherche Clinique Saint-Louis, Hôpital Saint-Louis, 75010 Paris, France
| | - Eric De Kerviler
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
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Transradial versus transfemoral access for liver cancer patients undergoing hepatic arterial infusion chemotherapy: Patient experience and procedural complications. J Vasc Interv Radiol 2022; 33:956-963.e1. [DOI: 10.1016/j.jvir.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022] Open
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Restrepo CR, Tabori NE, Sabri SS, Horton KM, Sivananthan G. Prospective Study of Radial Artery Occlusion Following Transradial Arterial Access during IR Procedures. J Vasc Interv Radiol 2021; 33:130-135. [PMID: 34718097 DOI: 10.1016/j.jvir.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/17/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To prospectively determine the rate of radial artery occlusion (RAO) in patients undergoing transradial access for intra-arterial interventions. MATERIALS AND METHODS Seventy-seven patients undergoing transradial access from August 2019 to March 2021 for 120 intra-arterial procedures (yttrium-90 mapping [n = 39] and radioembolization [n = 38], uterine artery embolization [n = 19], transarterial chemoembolization [n = 10], active bleed embolization [n = 8], angiomyolipoma embolization [n = 4], and other [n = 2]) were enrolled. The average patient age was 59 years ± 13.1 (range, 30-90 years), and 43 (55.8%) of the 77 patients were men. The patients underwent radial artery (RA) palpation, ultrasound evaluation, the Barbeau test, and the reverse Barbeau test prior to and following the intervention. Verapamil, nitroglycerin, and heparin were administered in a total of 114 (95%) of the 120 procedures prior to starting the procedure. The incidence of RAO and radial artery spasm (RAS) was calculated, and univariate logistic regression was performed to analyze the predictors of RAS. RESULTS The preprocedural RA diameter (3.0 mm ± 0.67) was not significantly different from the postprocedural RA diameter (3.0 mm ± 0.65, P = .904). The RAO rate was determined to be 0.8% (1/120), and this artery recanalized within 1 week. Due to the small number of occlusions, statistical analysis of predictors of RAO was not performed. The rate of RAS was 22.7% (27/119). None of the variables tested-including age, sex, RA diameter, initial versus repeat access, operator experience, and artery puncture technique-showed significant prediction for RAS. Patients were seen for follow-up after 111 (92.5%) of the 120 procedures. CONCLUSIONS Transradial access resulted in a <1% rate of RAO.
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Affiliation(s)
- Clark R Restrepo
- Department of Radiology, Medstar Georgetown University Hospital, Washington, DC. https://twitter.com/clarkrestrepo
| | - Nora E Tabori
- Department of Radiology, Georgetown Medical School, Medstar Washington Hospital Center, Washington, DC
| | - Saher S Sabri
- Department of Radiology, Georgetown Medical School, Medstar Washington Hospital Center, Washington, DC
| | - Keith M Horton
- Department of Radiology, Georgetown Medical School, Medstar Washington Hospital Center, Washington, DC
| | - Gajan Sivananthan
- Department of Radiology, Georgetown Medical School, Medstar Washington Hospital Center, Washington, DC.
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Frost JP, Najran P, Bell J, Mullan D. Radial Artery Access for Hepatic Chemosaturation: The First Description of Technical Feasibility. Cureus 2021; 13:e18852. [PMID: 34671515 PMCID: PMC8522136 DOI: 10.7759/cureus.18852] [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] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Chemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT® Delivery System, Delcath Systems Inc, Wilmington, Delaware) is an interventional radiology procedure that delivers high doses of melphalan, a chemotherapeutic agent, directly to the liver in patients with unresectable primary and secondary liver tumours. Traditionally, CS-PHP is delivered by arterial access via the femoral artery. However, there can be many risks and adverse effects associated with femoral artery punctures, such as retroperitoneal haemorrhage and haematoma formation. The monitoring and bed rest required following the removal of a femoral arterial catheter may also cause significant distress to patients as they remain immobile, potentially prolonging their stay in hospital. The radial artery is an alternative access point, with fewer reported adverse events and increased patient tolerance when compared with femoral access. This case report details the first reported use of Hepatic CHEMOSAT® therapy being delivered via the radial artery. Two patients received hepatic chemosaturation with no reported complications. This report demonstrates that access via the radial artery is a feasible alternative for the delivery of chemotherapy, which may reduce morbidity and the risks usually associated with femoral access.
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Affiliation(s)
- Joshua P Frost
- Radiology and Interventional Radiology, The Christie NHS Foundation Trust, Manchester, GBR
| | - Pavan Najran
- Radiology and Interventional Radiology, The Christie NHS Foundation Trust, Manchester, GBR
| | - Jon Bell
- Radiology and Interventional Radiology, The Christie NHS Foundation Trust, Manchester, GBR
| | - Damian Mullan
- Radiology and Interventional Radiology, The Christie NHS Foundation Trust, Manchester, GBR
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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: 2.0] [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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Rodriguez Caamaño I, Barranco-Pons R, Klass D, de Dios Las Cuevas M, Chirife OS, Aixut S. Distal Transradial Artery Access for Neuroangiography and Neurointerventions : Pitfalls and Exploring the Boundaries. Clin Neuroradiol 2021; 32:427-434. [PMID: 34258635 PMCID: PMC8276686 DOI: 10.1007/s00062-021-01039-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Introduction The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion. Aim To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access. Methods A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed. The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid compression protocol were also assessed. Results From March 2019 to July 2020 a total of 100 distal radial procedures were carried out and 53 diagnostic angiograms (53%) and 47 interventional procedures (47%) were included in the analysis. We achieved a 96% technical success, with a femoral crossover requirement in 3 cases (3%), and one conventional TRA crossover due to puncture failure. Of the patients 3 presented puncture site hematomas (3%) with no intervention required, 61 patients (61%) underwent the ultrarapid hemostasis protocol in association with a hemostatic pad. Ultrasound follow-up was performed in 20 patients (20%) at 1–2 months with 1 case of occlusion (5%) and 2 of radial stenosis (10%). In all 3 cases proximal radial artery remained patent. Conclusion The dTRA is a safe and feasible access route for angiography and neurointerventions. Using vasodilators prepuncture, we attained a variable increase in the vascular diameter facilitating puncture and reducing the risk of occlusion and vascular spasm. A rapid deflation protocol for postpuncture hemostasis does not significantly increase the hematoma rate.
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Affiliation(s)
| | | | | | | | | | - Sonia Aixut
- Hospital Universitari de Bellvitge, Barcelona, Spain
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11
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Lodha A, Giannopoulos S, Sumar R, Ratcliffe J, Gorenchtein M, Green P, Rollefson W, Stout CL, Armstrong EJ. Transradial endovascular intervention: Results from the Radial accEss for nAvigation to your CHosen lesion for Peripheral Vascular Intervention (REACH PVI) study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:115-120. [PMID: 34020900 DOI: 10.1016/j.carrev.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE The transradial approach has been proposed as an alternative to traditional transfemoral access for diagnostic and therapeutic purposes in several catheterization procedures. Historically, extended length devices for lower limb endovascular interventions have been limited. The aim of this study was to investigate the acute clinical outcomes of orbital atherectomy (OA) via transradial access (TRA) for the treatment of lower extremity peripheral artery disease (PAD). METHODS/MATERIALS REACH PVI was a multicenter, prospective, observational study (NCT03943160) including subjects with PAD and target lesion morphology appropriate for OA. All patients were followed post-procedure through the first standard of care follow-up visit. RESULTS A total of 50 patients were enrolled. In most cases the indication for intervention was disabling claudication (74.0%). Overall, 50 target lesions were treated, 92.0% of lesions were femoropopliteal and 8.0% were infrapopliteal. The average lesion length was 98.3 ± 87.5 mm and 78.0% of the lesions were severely calcified. Balloon angioplasty was performed in 98.0% of target lesions, while a stent was deployed in 16.0%. Treatment success was 98.0%; in only one case the result was sub-optimal (>30% stenosis with stent placement) and a significant dissection was reported. No serious distal embolization, serious thrombus formation or serious acute vessel closure were observed intra- or post-procedurally. CONCLUSIONS Transradial OA followed by percutaneous transluminal angioplasty for lower extremity PAD is feasible and demonstrates a favorable safety profile. Extended length devices such as the Extended Length Orbital Atherectomy System could further facilitate transradial endovascular procedures by increasing its spectrum of application.
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Affiliation(s)
- Ankur Lodha
- Cardiovascular Institute of the South - Lafayette, Lafayette, LA, United States
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, United States
| | - Riyaz Sumar
- Arizona Cardiovascular Research Center, Phoenix, AZ, United States
| | | | | | | | | | | | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, United States.
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Hadjivassiliou A, Kiemeneij F, Nathan S, Klass D. Ultrasound-guided access to the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions: a technical guide. EUROINTERVENTION 2021; 16:1342-1348. [PMID: 31380781 PMCID: PMC9724968 DOI: 10.4244/eij-d-19-00555] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Conventional radial access has been shown to have many advantages over the transfemoral approach. The risk of potential radial artery occlusion and subsequent hand ischaemia can be reduced further by accessing the vessel distally at the anatomical snuffbox, allowing maintenance of antegrade flow to the hand by the superficial palmar arch branch. Additional potential advantages of distal radial access in comparison to the conventional radial approach at the wrist include fewer puncture-site complications and faster post-procedural haemostasis as the vessel is very superficial. Furthermore, it provides another safe, non-femoral option for vascular access. The use of ultrasound guidance enables the operator to identify important anatomical landmarks and avoid injuring adjacent structures. We provide a detailed step-by-step guide for performing distal radial access using sonographic and anatomical correlation, thereby facilitating safe access and optimising technical success.
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Affiliation(s)
- Anastasia Hadjivassiliou
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Darren Klass
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada
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Kennedy P, Klass D, Chung J. Non-target digital ischemia in an ulnar artery distribution following transradial access: Case report and review of best practice techniques. J Vasc Access 2021; 23:628-631. [PMID: 33719726 PMCID: PMC9260484 DOI: 10.1177/11297298211000897] [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] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Patrick Kennedy
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, North York General Hospital, Toronto, ON, Canada
| | - Darren Klass
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - John Chung
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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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: 1.7] [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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Ruzsa Z, Csavajda Á, Nemes B, Deák M, Sótonyi P, Bertrand OF, Merkely B. Distal Radial Artery Access for Superficial Femoral Artery Interventions. JOURNAL OF ENDOVASCULAR THERAPY : AN OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS 2020. [PMID: 33044111 DOI: 10.1177/1526602820963022.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. MATERIALS AND METHODS Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. RESULTS Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). CONCLUSION SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mónika Deák
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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16
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Ruzsa Z, Csavajda Á, Nemes B, Deák M, Sótonyi P, Bertrand OF, Merkely B. Distal Radial Artery Access for Superficial Femoral Artery Interventions. J Endovasc Ther 2020; 28:255-261. [PMID: 33044111 PMCID: PMC8044606 DOI: 10.1177/1526602820963022] [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] [Indexed: 01/29/2023]
Abstract
Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mónika Deák
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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17
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Swersky A, Mohan P. Embolization of hemorrhage from a ruptured hepatocellular carcinoma via the false lumen of an aortic dissection using transradial access. J Card Surg 2020; 35:2375-2378. [PMID: 32720407 DOI: 10.1111/jocs.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Transcatheter arterial embolization (TAE) has been repeatedly shown as an effective method of controlling acute hemorrhage. Arterial access for TAE in the emergent setting is typically trans-femoral, though other routes are routinely used. The presence of abnormal vasculature such as an aortic dissection increases the difficulty of TAE. CASE REPORT This report details a case of acute hemorrhage likely from a ruptured hepatocellular carcinoma in which the celiac artery originated from the false lumen of a type B aortic dissection. CONCLUSION The false lumen was catheterized via left radial artery access and the bleeding hepatic arterial branch was successfully embolized.
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Affiliation(s)
- Adam Swersky
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Prasoon Mohan
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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18
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Schartz D, Young E, Guerin S. Transradial approach for pediatric interventions: A review and analysis of the literature. J Vasc Access 2020; 22:438-443. [PMID: 32781881 DOI: 10.1177/1129729820948688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population. METHODS We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic. RESULTS Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01). CONCLUSION Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.
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Affiliation(s)
- Derrek Schartz
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Emily Young
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stephen Guerin
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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19
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Safety and Efficacy of a Truncated Deflation Algorithm for Distal Transradial Access. J Vasc Interv Radiol 2020; 31:1328-1333. [DOI: 10.1016/j.jvir.2020.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
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20
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Pons RB, Caamaño IR, Chirife OS, Aja L, Aixut S, de Miquel MÁ. Transradial access for diagnostic angiography and interventional neuroradiology procedures: A four-year single-center experience. Interv Neuroradiol 2020; 26:506-513. [PMID: 32408785 PMCID: PMC7446594 DOI: 10.1177/1591019920925711] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The objective of this study was to assess the efficacy and safety of transradial access for diagnostic angiography and interventional neuroradiology procedures. METHODS This was a retrospective analysis of a single-center experience based on 225 patients attended between August 2015 and October 2019, in which transradial access was used for diagnostic angiography and endovascular interventions. Ultrasound-guided access was done at the level of the forearm or anatomical or snuffbox (distal transradial access). Conventional forearm transradial access was done in 179 procedures (right, left and bilateral in 169, 5 and 5, respectively), while distal transradial access was done in 46 cases (41 right and 5 left). Primary outcome measures included successful catheterization, need to change access, or technical complications. RESULTS In the group of 131 diagnostic angiographies, the technique success rate was 100% to target the right vertebral artery, 97% for the right internal carotid, 93.5% for the left internal carotid, 82% for the left vertebral artery, and 100% for both common and external carotid arteries. All patients were discharged within 2-4 h after the procedure. A total of 94 interventional procedures were performed, including aneurysms in 39 cases, stroke in 34, and other procedures (carotid stents, arteriovenous malformations, carotid-cavernous fistula) in the remaining 21. The overall technical success in both diagnostic angiographies and interventional procedures was 97.7%. In four cases of diagnostic angiography and in 1 intervention, it was necessary to switch from transradial access to transfemoral access. Three cases of hematoma related to the access site were recorded. CONCLUSIONS In our experience, transradial access is an alternative approach for diagnostic angiography and neuro-interventions.
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Affiliation(s)
- Roger Barranco Pons
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Rodríguez Caamaño
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Sabino Chirife
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Aja
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Aixut
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Ángeles de Miquel
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Fundació Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
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21
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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: 13] [Impact Index Per Article: 3.3] [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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22
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van Dijk LJD, van Noord D, van Mierlo M, Bijdevaate DC, Bruno MJ, Moelker A. Single-Center Retrospective Comparative Analysis of Transradial, Transbrachial, and Transfemoral Approach for Mesenteric Arterial Procedures. J Vasc Interv Radiol 2019; 31:130-138. [PMID: 31771892 DOI: 10.1016/j.jvir.2019.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess feasibility and safety of transradial access (TRA) compared with transfemoral access (TFA) and transbrachial access (TBA) for mesenteric arterial endovascular procedures. MATERIALS AND METHODS A retrospective cohort analysis was performed including all consecutive patients who underwent a mesenteric arterial procedure in a tertiary referral center between May 2012 and February 2018. Exclusion criteria were absence of data and lost to follow-up within 24 hours after the procedure. During the study period, 103 patients underwent 148 mesenteric arterial procedures (TBA, n = 52; TFA, n = 39; TRA, n = 57). Mean patient age was 64.3 years ± 13.3, and 91 patients (62%) were women. Primary outcomes were vascular access specified technical success rate and access site complication rate, as reported in hospital records. RESULTS Technical success rate specified for the vascular access technique did not differ between the 3 approaches (TBA 96%, TFA 87%, TRA 91%; TRA vs TBA, P = .295; TBA vs TFA, P = .112; TRA vs TFA, P = .524), and overall access site complication rate was not different between the 3 approaches (TBA 42%, TFA 23%, TRA 35%; TRA vs TBA, P = .439; TBA vs TFA, P = .055; TRA vs TFA, P = .208). However, more major access site complications were reported for TBA than for TRA or TFA (TBA 17%, TFA 3%, TRA 2%; TRA vs TBA, P = .005; TBA vs TFA, P = .026; TRA vs TFA, P = .785). CONCLUSIONS TRA is a safe and feasible approach for mesenteric arterial procedures comparable to TFA, but with a significantly lower major access site complication rate than TBA.
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Affiliation(s)
- Louisa J D van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands.
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Minke van Mierlo
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Diederik C Bijdevaate
- Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands
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23
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Chen YY, Liu P, Wu YS, Lin H, Chen X. Transradial vs transfemoral access in patients with hepatic malignancy and undergoing hepatic interventions: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13926. [PMID: 30593212 PMCID: PMC6314706 DOI: 10.1097/md.0000000000013926] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 12/02/2018] [Accepted: 12/07/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to compare transradial access (TRA) approach with transfemoral access (TFA) approach in patients undergoing hepatic interventions. METHODS We conducted a comprehensive search of the PubMed, Embase, and the Cochrane Library database to identify relevant available articles. Patients' preference, success rate, intra- and postoperative outcomes were analyzed. The risk difference (RD), relative risk (RR), and weighted mean difference (WMD) values were reported with 95% confidence intervals (CIs). We used RevMan 5.3 to perform the pooled analyses. RESULTS Nine cohort studies were included. A total of 1096 procedures were performed in 877 patients. Of those, 545 procedures (49.7%) were performed by TRA, and 551 procedures (50.3%) were performed by TFA. Patients were significantly prefer the TRA (86.5%) to the TFA (13.5%) (RD = 0.88, P < .00001). The procedure time in TRA groups was longer (WMD = 3.36, 95% CI 1.24-5.47, P = .002). But there were no significant difference in terms of success rate, fluoroscopy time, radiation dosage, contrast volume, and postoperative vascular complications. CONCLUSION For patients suffer from primary or secondary hepatic malignancy and undergoing hepatic interventions, the present meta-analysis demonstrated that patients prefer the TRA approach to the TFA approach. But the procedure time is longer in TRA group.
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Affiliation(s)
- Yuan-Yuan Chen
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Pan Liu
- Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Sichuan
| | - Yu-Shen Wu
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaopin Chen
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
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24
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Mortensen C, Chung J, Liu D, Ho S, Legiehn G, Machan L, Klass D. Prospective Study on Total Fluoroscopic Time in Patients Undergoing Uterine Artery Embolization: Comparing Transradial and Transfemoral Approaches. Cardiovasc Intervent Radiol 2018; 42:441-447. [DOI: 10.1007/s00270-018-2100-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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25
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A reality check in transradial access: a single-centre comparison of transradial and transfemoral access for abdominal and peripheral intervention. Eur Radiol 2018; 29:68-74. [DOI: 10.1007/s00330-018-5580-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/09/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
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26
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Loewenstern J, Welch C, Lekperic S, Bishay V, Ranade M, Patel RS, Kim E, Nowakowski FS, Lookstein RA, Fischman AM. Patient Radiation Exposure in Transradial versus Transfemoral Yttrium-90 Radioembolization: A Retrospective Propensity Score-Matched Analysis. J Vasc Interv Radiol 2018; 29:936-942. [PMID: 29753675 DOI: 10.1016/j.jvir.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare differences in patient radiation exposure (PRE) during transarterial yttrium-90 (90Y) radioembolization (TARE) between transradial access (TRA) and transfemoral access (TFA). MATERIALS AND METHODS A total of 810 consecutive first-time TARE procedures in patients from 2013 to 2017 were retrospectively reviewed. A propensity score-matching (PSM) analysis matched TRA and TFA groups on the basis of patient age, sex, weight, height, cancer type, 90Y microsphere type, and number of previous procedures from the same and opposite approaches. Matched groups were then compared by PRE measures fluoroscopy time (FT), dose-area product (DAP), and cumulative air kerma (AK). Effect size for each PRE measure was calculated. RESULTS Before PSM, TRA and TFA groups differed significantly in mean age, weight, and number of previous procedures from the same and opposite approach (all P < .05). After PSM, each group consisted of 302 procedures (overall, n = 604) and no longer differed in any procedure performed before surgery measure. TRA did not differ from the matched TFA group regarding median FT (9.50 vs 9.40 minutes, P = .095), median DAP (67,066 vs 67,219 mGy·cm2; P = .19), or median AK (323.63 vs 248.46 mGy; P = .16). Effect sizes were 0.068, 0.054, and 0.110 for FT, DAP, and AK, respectively. CONCLUSIONS No statistical differences were found for PRE measures between the matched TRA and TFA approach groups. Furthermore, practical effect sizes were considered to be small for AK and less than small for FT and DAP, and therefore, any differences in PRE between the radial and femoral approaches for TARE are minor and unlikely to be noticeable in everyday clinical practice.
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Affiliation(s)
- Joshua Loewenstern
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Colton Welch
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Safet Lekperic
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Vivian Bishay
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Mona Ranade
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Rahul S Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Edward Kim
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - F Scott Nowakowski
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Robert A Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Aaron M Fischman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029.
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