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Chen SX, Zhang B, Hao YX, Xiao H. Comparison of Distal Transradial and Femoral Access in Endovascular Treatment of Non-coronary Arterial Disease. Angiology 2024; 75:556-564. [PMID: 36919369 DOI: 10.1177/00033197231163358] [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] [Indexed: 03/16/2023]
Abstract
This study compared the efficacy and safety of distal transradial access (dTRA) and common femoral artery access (CFA) for endovascular treatment of non-coronary arterial disease. 102 interventions were divided into dTRA (n = 51) and CFA (n = 51) groups; the puncture success rate was 100% in both groups. The mean number of punctures and puncture time were greater in the dTRA than CFA group (1.86 vs 1.04 and 3.96 vs ≤1.00 min, p < .001 for both), whereas the access-related complication rate was comparable. The surgical success rate was higher in the CFA than dTRA group (98.0 vs 84.3, p = .036), and the operative time was longer in the dTRA than CFA group (99.09 vs 84.10 min, p = .017). The postoperative adverse event rate was not different between the dTRA and CFA groups. dTRA is a safe and feasible access for non-coronary arterial disease and is comparable to CFA in terms of puncture success, access-related complications, and major adverse events. The dTRA is inferior to CFA in the treatment of lower extremity arterial disease. Due to the increase in the operation time and the contrast medium volume in the dTRA, it is necessary to be vigilant about contrast nephropathy and late radiological random side effects.
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Affiliation(s)
- Shang-Xiong Chen
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Bin Zhang
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ying-Xue Hao
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hang Xiao
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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2
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Al-Azizi K, Moubarak G, Dib C, Sayfo S, Szerlip M, Thomas S, Hale S, Zyl JV, Settele RM, Gonzalez OR, Ventura SJ, DiMaio JM, Mack MJ, Potluri S. Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 1-Year Outcomes. Am J Cardiol 2024; 220:102-110. [PMID: 38432334 DOI: 10.1016/j.amjcard.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA) access in the anatomical snuffbox preserves the RA but safety and potential detrimental effects on hand function are unknown. We aimed to assess hand function and complications after DRA and PRA. In this single-center trial, 300 patients were randomly allocated 1:1 to cardiac catheterization through DRA or PRA. The primary end point of change in hand function from baseline to 1 year was a composite of the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, hand grip test, and thumb-forefinger pinch test. The secondary end points included access feasibility and complications. Of 216 patients with 1-year completed follow-up, 112 were randomly allocated to DRA and 104 to PRA, with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%, p = 0.25). Radial artery occlusion occurred in 1 PRA patient versus 2 in DRA. There was no significant difference in change of hand function, median (interquartile range) hand grip (DRA 0.7 [-3 to 4.5] vs PRA 1.3 [-2 to 4.3] kg, p = 0.57), pinch grip (DRA -0.1 [-1.1 to 1] vs PRA -0.3 [-1 to 0.7] kg, p = 0.66), and Quick DASH (DRA 0 [-6.6 to 2.3] vs PRA 0 [-4.6 to 2.9] points, p = 0.58). The composite of hand function was comparable between PRA and DRA. In conclusion, DRA is a safe strategy for cardiac catheterization, with a low complication rate. Compared with PRA, there is no increased risk of hand dysfunction or radial artery occlusion at 1 year.
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Affiliation(s)
- Karim Al-Azizi
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas.
| | | | - Chadi Dib
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Sameh Sayfo
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas; Baylor Scott and White Research Institute, Plano, Texas
| | - Sibi Thomas
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Sarah Hale
- Baylor Scott and White Research Institute, Plano, Texas
| | | | | | | | | | - J Michael DiMaio
- Baylor Scott and White Research Institute, Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Michael J Mack
- Baylor Scott and White Research Institute, Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Srinivasa Potluri
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
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3
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Korotkikh AV, Kashtanov MG. Overview of the distal radial access from the radial artery occlusion perspective. J Vasc Access 2024:11297298241250376. [PMID: 38708831 DOI: 10.1177/11297298241250376] [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: 05/07/2024] Open
Abstract
Conventional radial access in endovascular surgery has certain limitations, primarily associated with the presence of local complications and radial artery occlusion. Over the past 7 years, distal radial access has exploded into all areas of endovascular procedures, from interventional cardiology to vascular surgery and interventional oncology. However, puncture of the distal radial artery has its own nuances and features: a learning curve, the use of ultrasound navigation in the initial stages of mastering the access, limitations in patients with acute conditions (acute coronary syndrome and stroke). This review aims to analyze on important aspects of the procedure of distal radial access from preparation for it to hemostasis and to explore all data about the new roles of distal radial access in avoiding but also treating radial artery occlusion, as the first thing to begin with the development and implementation of new access.
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Affiliation(s)
| | - Maksim Gennadievich Kashtanov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Catheterization Laboratory, Tomsk, Russia
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4
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. A narrative review of history, advantages, future developments of the distal radial access. J Vasc Access 2024; 25:745-752. [PMID: 36262018 DOI: 10.1177/11297298221129416] [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] [Indexed: 11/17/2022] Open
Abstract
This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.
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Acar E, Izci S, Donmez I, Yilmaz MF, Ozgul N, Kayabası O, Gokce M, Güneş Y, Izgi IA, Kirma C. The Left D istal transradial access site co uld give a safe alter nate sit e for tra nsradial coronary in tervention (The Litaunent Study). Angiology 2024; 75:425-433. [PMID: 37345456 DOI: 10.1177/00033197231183226] [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] [Indexed: 06/23/2023]
Abstract
Transradial Access (TRA) is the suggested method when performing coronary procedures. TRA has several advantages over the transfemoral approach, but also some restrictions. The present study compared the efficacy and safety of the traditional proximal transradial approach (pTRA) with a newer technique known as the distal transradial approach (dTRA) for performing a coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients (n = 700) were placed into one of two categories (dTRA or pTRA) based on a random technique. The primary endpoint was RAO at follow-up. The secondary endpoints included the time required for sheath insertion, the rate of successful sheath insertion, rate of successful completion of CAG and PCI, total procedure time, total fluoroscopy time, total radiation dose, total contrast volume used, pain perception (visual analog scale 0-10), and hemostasis duration. dTRA patients had more skin punctures, failed punctures, failed wiring, overlap of access sites, sheath insertion time, and pain evaluation scale, while the pTRA group had more hemostasis time and first-time cannulation. RAO and pseudoaneurysm (PseA) were lower in the dTRA group. In this randomized study, dTRA had lower RAO and PseA than pTRA. However, multicenter, larger-patient trials are needed to provide definitive evidence.
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Affiliation(s)
- Emrah Acar
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Servet Izci
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Ibrahim Donmez
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Fatih Yilmaz
- Department of Cardiology, Siyami Ersek Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Neryan Ozgul
- Department of Cardiology, Kastamonu Training and Research Hospital, Kastamonu, Turkey
| | - Oguz Kayabası
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - Mustafa Gokce
- Department of Cardiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Yilmaz Güneş
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Ibrahim Akin Izgi
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Cevat Kirma
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. Distal Radial Access: Is There a Clinical Benefit? Cardiol Rev 2024; 32:110-113. [PMID: 36538417 DOI: 10.1097/crd.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For decades, the femoral artery has been the most common vascular access for diagnostic and therapeutic endovascular procedures. However, over the past 20 years, radial access has been gaining popularity, as it is a safer and allows practical access with more benefits. Recently, the new distal radial access has proven to be an equal or perhaps even safer vascular access for diagnostic and therapeutic coronary and noncoronary interventions. Today, this access should be in the arsenal of every interventional surgeon.
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Affiliation(s)
- A V Korotkikh
- From the Cardiac Surgery Clinic, Amur State Medic al Academy, Blagoveshchensk, Russian Federation
| | - A M Babunashvili
- Interventional Cardiology Department, Sechenov University, Moscow, Russian Federation
| | - A N Kazantsev
- Surgery Department, City Alexandrovskaya Hospital, St. Petersburg, Russian Federation
| | - Z S Annaev
- Neurosurgery Department, Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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Al‐Azizi K, Moubarak G, Dib C, Sayfo S, Szerlip M, Thomas S, McCracken J, Smith A, Kelavkar U, Hale S, Van Zyl J, McCoy SL, Lanfear AT, Banwait JK, Ravindranathan P, Chionh K, DiMaio JM, Mack MJ, Potluri S. Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 30-Day Outcomes of the DIPRA Study. J Am Heart Assoc 2023; 12:e030774. [PMID: 37889176 PMCID: PMC10727396 DOI: 10.1161/jaha.123.030774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023]
Abstract
Background Proximal radial artery (pRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (dRA) access in the anatomical snuffbox preserves the radial artery, but safety and potential detrimental effects on hand function are unknown. Methods and Results In the DIPRA (Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention) study, a single-center trial, 300 patients were randomized 1:1 to cardiac catheterization through dRA or pRA. The primary end point of change in hand function from baseline to 30 days was a composite of the QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire, hand-grip test, and thumb forefinger pinch test. Secondary end points included access feasibility and complications; 254 of 300 patients completed follow-up at 30 days; of these, 128 were randomized to dRA and 126 to pRA with balanced demographic and procedural characteristics. Both groups had similar rates of access site bleeding (dRA 0% versus pRA 1.4%; P=0.25). Six patients with dRA failed access compared with 2 patients with pRA. Radial artery occlusion occurred in 2 pRA versus none in dRA. There were no significant differences in change in hand function, median hand-grip (dRA 0 [-3.2, 3.3] versus pRA 0.7 [-2.3, 3.3] kg; P=0.21), pinch-grip (dRA -0.3 [-1.2, 0.5] versus pRA 0 [-0.9, 0.9] kg; P=0.09), and QuickDASH (dRA 0 [-4.6, 2.3] versus pRA 0 [-4.6, 2.3] points, P=0.96). There was no significant difference in the composite of hand function between pRA and dRA. Conclusions dRA is a safe strategy for cardiac catheterization with a low complication rate. Compared with pRA, there is no increased risk of hand dysfunction at 30 days. Registration URL: https://www.ClinicalTrials.gov. Unique identifier: NCT04318990.
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Affiliation(s)
- Karim Al‐Azizi
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | | | - Chadi Dib
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Sameh Sayfo
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Molly Szerlip
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Sibi Thomas
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | | | - Adam Smith
- Baylor Scott and White Research InstitutePlanoTX
| | - Uma Kelavkar
- Baylor Scott and White Research InstitutePlanoTX
| | - Sarah Hale
- Baylor Scott and White Research InstitutePlanoTX
| | | | | | | | | | | | | | - J. Michael DiMaio
- Baylor Scott and White Research InstitutePlanoTX
- Department of Cardiothoracic SurgeryBaylor Scott and White The Heart HospitalPlanoTX
| | - Michael J. Mack
- Baylor Scott and White Research InstitutePlanoTX
- Department of Cardiothoracic SurgeryBaylor Scott and White The Heart HospitalPlanoTX
| | - Srinivasa Potluri
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
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8
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Wang H, Cui C, Liu H, Zhang B, Tian T, Ye S, Yang W, Yuan J, Xu B, Gao L. Preliminary Study on Retrograde Recanalization of Radial Artery Occlusion Through Distal Radial Artery Access: a Single-Center Experience. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07490-9. [PMID: 37498472 DOI: 10.1007/s10557-023-07490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Radial artery occlusion (RAO) is an unresolved complication after transradial artery (TRA) puncture. The aim of this observational study was to assess the feasibility and safety of retrograde recanalization of RAO through distal transradial access (dTRA). METHODS From June 2021 to March 2022, 28 consecutive patients with successful puncture and intubation through the dTRA in the anatomical snuffbox and RAO confirmed by angiography were enrolled. RESULTS Among the 28 patients, 27 (96.4%) patients with RAO were successfully retrogradely recanalized through the dTRA and successfully underwent coronary angiography or coronary intervention. After the procedure, only 1 (3.7%) patient developed a forearm hematoma, and there were no other bleeding complications or nerve disorders. CONCLUSIONS DTRA is a safe and feasible approach for retrograded recanalization of RAO, with a high procedure success rate and few complications.
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Affiliation(s)
- Huanhuan Wang
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Yunnan Fuwai Cardiovascular Hospital, Kunming, Yunnan Province, China
| | - Cheng Cui
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Haiming Liu
- The People's Hospital of Dehui City, Dehui, Jilin Province, China
| | - Bo Zhang
- Yunnan Fuwai Cardiovascular Hospital, Kunming, Yunnan Province, China
| | - Tao Tian
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Shaodong Ye
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Weixian Yang
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Lijian Gao
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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Wang H, Liu D, Guo J, Heisha N, Wang L, Zhang Q, Han Y, Wang X, Zhang B, Yuan J, Gao L. Analysis of the Efficacy and Safety of Coronary Catheterization through Distal Transradial Access: A Single-Center Data. Cardiovasc Ther 2023; 2023:2560659. [PMID: 37228484 PMCID: PMC10205404 DOI: 10.1155/2023/2560659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/03/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Background and Aims The distal transradial access (dTRA) is a new puncture site for coronary catheterization. We sought to evaluate the feasibility, safety, and complication rates of using the dTRA for cardiac catheterization in Chinese patients. Methods A total of 263 consecutive patients who underwent catheterization through the dTRA were enrolled. The primary endpoint of the study was the rate of conversion to another access site due to the impossibility of successful artery puncture or intubation. Secondary safety endpoints were the rates of bleeding-related complications and nerve disorders. Results Among 263 patients, the puncture success rate was 96.2% (253/263). Eleven patients were successfully punctured, but the guide wire was difficult to advance. One patient had intubation failure, and the success rate of intubation was 91.6% (241/263). Two hundred thirty-three patients underwent puncture via the right dTRA, 5 patients underwent puncture via the left dTRA, and 3 patients underwent puncture via the bilateral dTRA. A total of 158 (65.6%) patients underwent coronary angiography, and 83 (34.4%) patients underwent percutaneous coronary intervention. After the procedure, only 2 (0.8%) patients had mild bleeding at the puncture site, 2 (0.8%) had a forearm hematoma, and no patient had a nerve disorder. Conclusions DTRA has a low incidence of complications, making it a safe and effective technique for cardiac catheterization.
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Affiliation(s)
- Huanhuan Wang
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Liu
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Jidong Guo
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Nuerbahati Heisha
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Lei Wang
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Qiang Zhang
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Yihui Han
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Xiping Wang
- Shihezi People's Hospital, The Third Affiliated Hospital of Shihezi University School of Medicine, Xinjiang, China
| | - Bo Zhang
- Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijian Gao
- National Clinical Research Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Minici R, Serra R, Giurdanella M, Talarico M, Siciliano MA, Carrafiello G, Laganà D. Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver. J Pers Med 2023; 13:jpm13040640. [PMID: 37109026 PMCID: PMC10142661 DOI: 10.3390/jpm13040640] [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: 03/12/2023] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver. METHODS This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access. RESULTS Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group. CONCLUSIONS Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Marco Giurdanella
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Marisa Talarico
- Cardiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | | | | | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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11
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Takamatsu S, Kagiyama N, Sone N, Tougi K, Yamauchi S, Yuri T, Ii N, Sugimoto T, Masutani M, Hirohata A. Impact of radial compression protocols on radial artery occlusion and hemostasis time in coronary angiography. Cardiovasc Interv Ther 2023; 38:202-209. [PMID: 36478329 PMCID: PMC10020254 DOI: 10.1007/s12928-022-00896-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidence-based protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, in the conventional protocol, fixed amount of air was removed soon after the procedure, 2 h later, and 3 h later, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1842 patients (71 ± 10 years old, 77% male) were included. Compared with the traditional protocol group (n = 1001), the new protocol group (n = 841) had a significantly lower rate of dual antiplatelet therapy (35% and 24% in the traditional and new groups, respectively, p < 0.001). The time required for complete hemostasis was approximately one-third with the new protocol (190 ± 16 and 66 ± 32 min, p < 0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p < 0.001). After adjusting for covariates, the new protocol was associated with a reduced risk of RAO (odds ratio 0.10, p < 0.001) and a shorter hemostasis time (odds ratio 0.01, p < 0.001). The new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.
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Affiliation(s)
- Sachiko Takamatsu
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
- Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan.
| | - Naohiko Sone
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kiyotaka Tougi
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Shuichiro Yamauchi
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Takuya Yuri
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Nobuhisa Ii
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Tomoko Sugimoto
- Department of Nursing, Hakuhoukai Central Hospital, Hyogo, Japan
| | | | - Atsushi Hirohata
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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12
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Escutia-Cuevas HH, Alcantara Melendez M, Jiménez-Valverde AS, Zaragoza-Rodriguez G, Vargas-Cruz A, Garcia-Garcia JF, Ordonez-Salazar BA, Flores-Morgado A, Orozco Guerra G, Renteria-Valencia DA. Feasibility of distal transradial access for coronary angiography and percutaneous coronary intervention: an observational and prospective study in a Latin-American Centre. Acta Cardiol 2023; 78:55-63. [PMID: 34979883 DOI: 10.1080/00015385.2021.2015546] [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: 11/01/2022]
Abstract
BACKGROUND Distal transradial access (dTRA) as a refinement of the conventional transradial access (TRA) has advantages in terms of risk of radial artery occlusion (RAO). In order to evaluate the real-world feasibility and safety of dTRA as the default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI) in a Latin-American centre, this prospective observational registry was conducted. METHODS Consecutive patients with a prior assessment for CAG and/or PCI were enrolled in this single-centre prospective registry from October 2018 to March 2019. The primary endpoints were the success rate of CAG and PCI. Secondary endpoints included the success rate of puncture of the distal radial artery, complications at the puncture site and puncture time. RESULTS The success rates of CAG and PCI were 100% (155/155) and 97% (69/71), respectively. Puncture time and fluoroscopic time were 52 ± 19 seconds and 16.3 ± 35.4 minutes, respectively. Haemostasis time was 142 ± 45 min. A total of 19 (12.5%) puncture site complications occurred, including 18 (11.6%) minor haematomas and one (0.6%) arterial perforation, in which the artery was patent at the one-month follow-up. Five patients complained of left thumb numbness at a one-month follow-up. No distal radial artery occlusion, pseudoaneurysm, or arteriovenous fistula occurred. CONCLUSIONS The success and complication rates of ldTRA support the feasibility and safety of this procedure using the appropriate materials in previously selected patients.
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Affiliation(s)
| | | | | | | | - Antonio Vargas-Cruz
- Department of Interventional Cardiology, National Medical Center, Mexico City, Mexico
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13
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Li F, Shi GW, Yu XL, Song RX, Xiao JQ, Huang HM, Li LM, Zhang LY, Gong C, Cai GJ. Safety and efficacy of coronary angiography and percutaneous coronary intervention via distal transradial artery access in the anatomical snuffbox: a single-centre prospective cohort study using a propensity score method. BMC Cardiovasc Disord 2022; 22:74. [PMID: 35236288 PMCID: PMC8892764 DOI: 10.1186/s12872-022-02518-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the safety and efficacy of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal transradial artery access (d-TRA). METHODS For this single-centre prospective cohort study, a total of 1066 patients who underwent CAG or PCI procedures from September 2019 to November 2020 were included. Patients were divided into two groups: the d-TRA group (346) and the conventional transradial artery access (c-TRA) group (720) based on access site. A total of 342 pairs of patients were successfully matched using propensity score matching (PSM) for subsequent analysis. RESULTS No significant differences in puncture success rate, procedural method, procedural time, sheath size, contrast dosage or fluoroscopy time were noted between the two groups. The puncture time in the d-TRA group was longer than that in the c-TRA group (P < 0.01), and the procedure success rate was lower than that in the c-TRA group (90.94% vs. 96.49%, P = 0.01). The haemostasis time in the d-TRA group was shorter than that in the c-TRA group (P < 0.01), and the visual analogue scale (VAS) was lower than that in the c-TRA group (P < 0.01). In addition, the prevalence of bleeding and haematoma in the d-TRA group was lower than that in the c-TRA group (1.75% vs. 7.31%, P < 0.01; 0.58% vs. 3.22%, P = 0.01, respectively). No significant difference in the incidence of numbness was noted between the two groups. No other complications were found in two groups. CONCLUSION d-TRA is as safe and effective as c-TRA for CAG and PCI. It has the advantages of improved comfort and fewer complications. Trail registration Chinese Clinical Trial Registry, ChiCTR1900026519.
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Affiliation(s)
- Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Gan-Wei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Xiao-Long Yu
- Department of Ultrasonic, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Rui-Xiao Song
- Department of Ultrasonic, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Jian-Qiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Hao-Min Huang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - La-Mei Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Liu-Yan Zhang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Chun Gong
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Gao-Jun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China.
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14
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Aminian A, Sgueglia GA, Wiemer M, Gasparini GL, Kefer J, Ruzsa Z, van Leeuwen MA, Vandeloo B, Ungureanu C, Kedev S, Iglesias JF, Leibundgut G, Ratib K, Bernat I, Barriocanal I, Borovicanin V, Saito S. Distal versus conventional radial access for coronary angiography and intervention: Design and rationale of DISCO RADIAL study. Am Heart J 2022; 244:19-30. [PMID: 34666014 DOI: 10.1016/j.ahj.2021.10.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis. Recently, distal radial access (DRA) has emerged as a promising alternative to TRA, yielding potential for minimizing the risk of RAO. However, an international multicenter randomized comparison between DRA, and conventional TRA with respect to the rate of RAO is still lacking. TRIAL DESIGN DISCO RADIAL is a prospective, multicenter, open-label, randomized, controlled, superiority trial. A total of 1300 eligible patients will be randomly allocated to undergo coronary angiography and/or percutaneous coronary intervention (PCI) through DRA or TRA using the 6 Fr Glidesheath Slender sheath introducer. Extended experience with both TRA and DRA is required for operators' eligibility and optimal evidence-based best practice to reduce RAO systematically implemented by protocol. The primary endpoint is the incidence of forearm RAO assessed by vascular ultrasound at discharge. Several important secondary endpoints will also be assessed, including access-site cross-over, hemostasis time, and access-site related complications. SUMMARY The DISCO RADIAL trial will provide the first large-scale multicenter randomized evidence comparing DRA to TRA in patients scheduled for coronary angiography or PCI with respect to the incidence of RAO at discharge.
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15
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Distal or Traditional Transradial Access Site for Coronary Procedures: A Single-Center, Randomized Study. JACC Cardiovasc Interv 2021; 15:22-32. [PMID: 34922888 DOI: 10.1016/j.jcin.2021.09.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography and percutaneous coronary interventions. BACKGROUND The recommended approach for coronary procedures is TRA. However, it is associated with radial artery occlusion (RAO). The dTRA could potentially decrease the incidence of RAO. METHODS One thousand forty-two consecutive patients were randomized (1:1) to right dTRA or TRA. The primary endpoint was the rate of RAO, which was evaluated by Doppler ultrasound at 60 days after randomization. RESULTS Five hundred eighteen and 524 patients were randomized to dTRA and TRA, respectively. Follow-up Doppler evaluation of the radial artery was accomplished in 404 (78.0%) patients in the dTRA group and 392 (74.8%) in the TRA group. The rate of RAO was significantly reduced in the dTRA group compared with TRA group (3.7% vs 7.9%, respectively; P = 0.014). The rate of successful sheath insertion was lower in the dTRA group compared with the TRA group (78.7% vs 94.8%, respectively; P < 0.001). More punctures (median = 2 [IQR: 1-3] vs median = 1 [IQR: 1-2]; P < 0.001) and a longer time (120 vs 75 seconds; P < 0.001) were required for sheath insertion in the dTRA group compared with the TRA group. The hemostasis time was shorter in the dTRA group compared with the TRA group (60 vs 120 minutes; P < 0.001). The dose area product was higher in the dTRA group (median = 32,729 in the dTRA vs 28,909 cGy/cm2 in the TRA group; P = 0.02). No significant differences were observed in the secondary safety endpoints (bleeding [Bleeding Academic Research Consortium ≥ 2] and severe radial artery spasm). CONCLUSIONS According to our study, dTRA was associated with a lower rate of forearm RAO, a shorter time of hemostasis, a higher crossover rate and dose area product, and a longer procedural time compared with TRA.
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16
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Achim A, Szűcsborus T, Sasi V, Nagy F, Jambrik Z, Nemes A, Varga A, Bertrand OF, Ruzsa Z. Distal radial secondary access for transcatheter aortic valve implantation: The minimalistic approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:152-157. [PMID: 34848177 DOI: 10.1016/j.carrev.2021.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach. METHODS As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days). RESULTS From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%. CONCLUSION The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.
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Affiliation(s)
- Alexandru Achim
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary; Medicala 1 Invasive Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Tamás Szűcsborus
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Viktor Sasi
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltán Jambrik
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Albert Varga
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | | | - Zoltán Ruzsa
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary.
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Koury A, Monsignore LM, de Castro-Afonso LH, Abud DG. Safety of ultrasound-guided distal radial artery access for abdominopelvic transarterial interventions: a prospective study. ACTA ACUST UNITED AC 2021; 26:570-574. [PMID: 32673202 DOI: 10.5152/dir.2020.19543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to evaluate ultrasound-guided distal radial artery (DRA) access to perform abdominopelvic endovascular procedures. METHODS A prospective, observational study was carried out in a single center between December 2017 and February 2019. Forty-two abdominopelvic endovascular procedures were performed by the same operator in 37 patients with DRA access using a 5 F sheath. Most patients were male (67.6%) with a mean age of 62.0±11.4 years (age range, 27.6-82.8 years). Patient characteristics, including Barbeau's test classification, radial and ulnar sizes and technical success, were evaluated. Patients with a DRA smaller than 1.7 mm could not be safely punctured and were not included. RESULTS Procedures included chemoembolization of hepatocellular carcinoma in 35 cases (83.3%), embolization of hepatic metastasis in neuroendocrine tumors in 4 cases (9.5%) and other embolization procedures in 3 cases (7.1%). The mean diameters of the DRA, proximal radial artery and proximal ulnar artery were 2.31, 2.63, and 2.09 mm, respectively. Out of 42 DRA puncture attempts, 97.6% (41/42) were successfully performed. There were no postoperative complications related to the access site, such as pain, palsy, paresthesia, occlusion, finger ischemia, bleeding, hematoma, and pseudoaneurysm. Transient forearm discomfort was reported in 7.1% of patients (3/42); one occurrence was associated with kinking rectification, and two occurrences were attributed to small arteries and/or vasospasm. CONCLUSION Ultrasound-guided DRA access seems to be feasible and safe to perform in abdominopelvic endovascular procedures in patients with a DRA considered amenable to be safely punctured, with high technical success rates.
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Affiliation(s)
- Adib Koury
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, São Paulo, Brazil
| | - Luis Henrique de Castro-Afonso
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, São Paulo, Brazil
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18
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Lee OH, Kim Y, Son NH, Roh JW, Im E, Cho DK, Choi D. Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:jcm10153438. [PMID: 34362221 PMCID: PMC8348546 DOI: 10.3390/jcm10153438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022] Open
Abstract
Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2–4.3], 3.3% [2.3–4.0], 2.6% [1.2–4.9], and 27.0% [13.5–29.3] in the DRA (n = 35), PRA (n = 24), FA (n = 26), and crossover (n = 9) groups, respectively (p < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.
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Affiliation(s)
- Oh-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
- Correspondence: ; Tel.: +82-13-5189-8567
| | - Nak-Hoon Son
- Data Science Team (Biostatistician), Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea;
| | - Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Eui Im
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
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19
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Hoffman H, Bunch KM, Mikhailova T, Cote JR, Ashok Kumar A, Masoud HE, Gould GC. Transition from Proximal to Distal Radial Access for Diagnostic Cerebral Angiography: Learning Curve Analysis. World Neurosurg 2021; 152:e484-e491. [PMID: 34098135 DOI: 10.1016/j.wneu.2021.05.125] [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: 02/25/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Distal transradial access (dTRA) has several advantages compared with proximal transradial access (pTRA) for cerebral angiography. The learning curve for transitioning from pTRA to dTRA has not been described. METHODS Retrospective analysis of the first 75 diagnostic cerebral angiograms performed with dTRA by a single operator was performed. Outcomes included time for sheath insertion, sheath to first vessel time, procedure duration, fluoroscopy time, radiation dose, and contrast volume. Their associations with procedure number were evaluated with multivariate linear regressions, segmented linear regression, and locally weighted regression (LOESS). RESULTS The mean age of patients was 56.1 years and 61.3% were female. Seventy-four of 75 angiograms were successfully completed with dTRA. There were 3 minor and no major complications. After adjusting for covariates, sheath to first vessel time (β = -0.50, P < 0.001) and procedure duration (β = -0.26, P = 0.002) were associated with procedure number. Time for sheath insertion, fluoroscopy time, radiation dose, and contrast volume were not associated with procedure number. Segmented linear regression identified break-points of 33 for sheath to first vessel time and 11 for procedure duration, which corresponded to the procedure number after which these outcomes trended down. LOESS models for time to sheath placement, procedure duration, fluoroscopy time, and radiation dose predicted minimum values between procedures 40-50. CONCLUSIONS Transitioning from pTRA to dTRA for diagnostic cerebral angiography is feasible and safe. The learning curve is overcome between procedures 11 and 33, and further refinement in performance occurs through procedures 40-50.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA.
| | - Katherine M Bunch
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Tatiana Mikhailova
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - John R Cote
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Apeksha Ashok Kumar
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Hesham E Masoud
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Grahame C Gould
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA
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Lee OH, Roh JW, Im E, Cho DK, Jeong MH, Choi D, Kim Y. Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions. J Clin Med 2021; 10:jcm10102204. [PMID: 34069701 PMCID: PMC8161320 DOI: 10.3390/jcm10102204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients.
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Affiliation(s)
- Oh-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Eui Im
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea;
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
- Correspondence: ; Tel.: +82-13-5189-8567
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Al-Azizi KM, Idris A, Christensen J, Hamandi M, Hale S, Martits-Chalangari K, Van Zyl JS, Ravindranathan P, Banwait JK, Mcckracken J, Smith A, Apakama G, Swim J, Dolton P, Chionh K, Dimaio M, Thomas S, Szerlip M, Sayfo S, Dib C, Mack M, Potluri S. Distal versus proximal radial artery access for cardiac catheterization and intervention: Design and rationale of the DIPRA trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:104-109. [PMID: 33926835 DOI: 10.1016/j.carrev.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Radial artery (RA) catheterization is the access of choice over femoral artery access for most interventional vascular procedures given its safety and faster patient recovery. There has been growing interest in distal radial artery (dRA) access as an alternative to the conventional proximal radial artery (pRA) access. Preserving the RA is important which serves as a potential conduit for future coronary artery bypass surgery, dialysis conduit or preserve the artery for future cardiovascular procedures. The dRA runs in close proximity to the radial nerve, which raises the concern of potential detrimental effects on hand function. STUDY DESIGN The Distal versus Proximal Radial Artery Access for cardiac catheterization and intervention (DIPRA) trial is a prospective, randomized, parallel-controlled, open-label, single center study evaluating the outcomes of hand function and effectiveness of dRA compared to pRA access in patients undergoing cardiac catheterization. The eligible subjects will be randomized to dRA and pRA access in a (1:1) fashion. The primary end point is an evaluation of hand function at one and twelve months follow-up. Secondary end points include rates of access site hematoma, access site bleeding, other vascular access complications, arterial access success rate, and RA occlusion at one and twelve months follow up. CONCLUSION Effects of dRA on hand function remains unknown and it's use questionable in the presence of a widely accepted pRA. DIPRA trial is designed to determine the safety and effectiveness of dRA for diagnostic and interventional cardiovascular procedures compared to the standard of care pRA.
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Affiliation(s)
- Karim M Al-Azizi
- Interventional Cardiology and Structural Heart Disease, Texas A&M University College of Medicine, The Heart Hospital - Plano, Baylor Scott & White Health, 1100 Allied Dr, Plano, TX 75093, United States of America.
| | - Amr Idris
- The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Jared Christensen
- The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Mohanad Hamandi
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Sarah Hale
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | | | - Johanna S Van Zyl
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Preethi Ravindranathan
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Jasjit K Banwait
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Julie Mcckracken
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Adam Smith
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Ginika Apakama
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Jennifer Swim
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Penni Dolton
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Kristen Chionh
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Michael Dimaio
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Sibi Thomas
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Molly Szerlip
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Sameh Sayfo
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Chadi Dib
- Interventional Cardiology, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Michael Mack
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Srinivasa Potluri
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
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Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting. JACC Cardiovasc Interv 2021; 14:892-906. [PMID: 33888235 DOI: 10.1016/j.jcin.2021.02.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 01/14/2023]
Abstract
Among patients undergoing percutaneous coronary procedures, transradial access, compared with transfemoral access, is associated with a reduced risk for complications including mortality, especially in higher risk patients. However, transradial access is limited by radial artery occlusion (RAO) that despite being mostly asymptomatic because of the extensive anastomoses between the forearm arteries restricts future use of the same radial artery. Distal radial access (DRA) in the anatomic snuffbox or on the dorsum of the hand has recently gained global popularity as an alternative access route for vascular procedures. A strong anatomic and physiological rationale yields potential for significantly reduced risk for RAO and positive impact on procedural outcome for better patient care. Indeed, currently published studies buttress very low rates of RAO after DRA, hence supporting its development. The authors provide an analysis of the foundation of DRA, provide historical background, and offer a critical review of its current status and future directions. Also, given the limited evidence currently available to properly perform DRA in the real world, consensus opinion on what is considered optimal practice is also presented to supplement this document and enhance the implementation of DRA while minimizing its complications.
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Lucreziotti S, Persampieri S, Gentile D, Barbieri L, Salerno-Uriarte D, Valli F, Sabatelli L, Panzacchi G, Centola M, Carugo S. Access-site hematoma in distal and conventional transradial access: a randomized trial. Minerva Cardiol Angiol 2021; 70:129-137. [PMID: 33703855 DOI: 10.23736/s2724-5683.21.05483-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Distal transradial access (dTRA) has been recently proposed as an innovative access for coronary procedures and a valuable alternative to conventional transradial access (cTRA). The aim of this study was to assess the safety of dTRA versus cTRA in patients undergoing percutaneous coronary angiography and intervention. METHODS In this single-center randomized trial, consecutive patients admitted for stable cardiac condition or acute coronary syndrome (ACS) were assigned to dTRA or cTRA. The primary endpoint was an early discharge after transradial stenting of coronary arteries (EASY) grade ≥II access-site hematoma (ASH). Vascular access failure, radial artery occlusion (RAO) at hospital discharge , 30-day rates of death, myocardial infarction, stroke and bleeding not related to coronary artery bypass grafting were considered as secondary endpoints. RESULTS A total of 204 patients were included and randomized to dTRA (n=100) or cTRA (n=104). The two populations were similar, except for a higher percentage of ACS in the dTRA than in the cTRA group (38% versus 24%, P=0.022). The rate of EASY grade ≥II ASH was lower in dTRA than in cTRA patients, but the difference was not statistically significant (4% versus 8.4%, respectively, P=0.25). Vascular access failure was more frequent in dTRA patients than in cTRA patients (34% versus 8.7%, P<0.0001). We detected no case of RAO at hospital discharge and similar rates of 30-day adverse events in both groups. CONCLUSIONS DTRA is safe and feasible. When compared to cTRA, dTRA is technically more demanding and limited by more frequent crossover to an alternative vascular access.
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Affiliation(s)
- Stefano Lucreziotti
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy -
| | - Simone Persampieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Domitilla Gentile
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Diego Salerno-Uriarte
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Federica Valli
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Ludovico Sabatelli
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Panzacchi
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Marco Centola
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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Distal Transradial Access for Coronary Angiography and Interventions. Curr Probl Cardiol 2020; 46:100714. [PMID: 33071036 DOI: 10.1016/j.cpcardiol.2020.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022]
Abstract
Coronary angiography is one of the most common procedures done in the United States and in other developed countries. For decades, the femoral artery has been the most common vascular access site utilized for this procedure. However, the radial access has been gaining popularity for being a safer and yet practical vascular access with substantial benefits. More recently, the novel distal transradial approach has proven to be an equally or perhaps safer vascular access for diagnostic and interventional coronary and noncoronary procedures. This technique should be in every interventional cardiologist's arsenal.
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A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention. J Interv Cardiol 2020; 2020:7342732. [PMID: 32982609 PMCID: PMC7495218 DOI: 10.1155/2020/7342732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Background Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported. Method Overall, 137 patients (144 procedures) who underwent CAG or PCI using dTRA between September 2018 and February 2019 were investigated. These patients were classified into two groups: C (dTRA with conventional punctures; 76 patients, 79 procedures) and U (dTRA with ultrasound-guided punctures; 61 patients, 65 procedures) groups. Successful procedural rate, procedural outcomes, and complication rate during hospital stays were compared between the two groups. Results The procedural success rate was significantly higher in the U group than in the C group (97% vs. 87%, P=0.0384). However, the rate of PCI, puncture time, total fluoroscopy time, the volume of contrast medium, the rate of access-site ecchymosis, and incidence of nerve disorder were similar between the two groups. Additionally, radial artery occlusion after the procedure did not occur in this study. Conclusion The ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. However, there were no significant differences in puncture time and complication rate between the two procedures.
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Garg R, Fu D, McRee C, Anderson K, Kennedy K, Aronow HD, Tuohy C, Abbott JD. Outcomes of Transradial Approach to Percutaneous Coronary Intervention in End-Stage Renal Disease Patients on Dialysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1131-1135. [DOI: 10.1016/j.carrev.2020.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 11/15/2022]
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27
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Cai G, Huang H, Li F, Shi G, Yu X, Yu L. Distal transradial access: a review of the feasibility and safety in cardiovascular angiography and intervention. BMC Cardiovasc Disord 2020; 20:356. [PMID: 32758150 PMCID: PMC7409500 DOI: 10.1186/s12872-020-01625-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transradial access (TRA) has been considered as the default choice in cardiac catheterization. Although infrequent, vascular complications of this approach remain. Recently, the distal transradial approach (dTRA) in cardiac catheterization was reported by interventionalists. METHODS We retrieved the relevant literatures and reviewed the safety and feasibility of this novel approach in cardiac catheterization. RESULTS The dTRA for cardiac intervention has superior safety and satisfaction. As a novel approach for cardiac catheterization, access related complications should also be considered by operators, such as RAO, radial spasm, bleeding and haematoma, and injury of the superficial branch of the radial nerve. CONCLUSIONS The dTRA in cardiovascular angiography and intervention was safe and feasible.
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Affiliation(s)
- Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Haomin Huang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Xiaolong Yu
- Science and Education Section, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
| | - Lei Yu
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province China
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Transradial access through the anatomical snuffbox: Results of a feasibility study. Hellenic J Cardiol 2020; 62:201-205. [DOI: 10.1016/j.hjc.2020.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/24/2022] Open
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Distal Radial and Ulnar Arteries: the Alternative Forearm Access. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:1. [DOI: 10.1007/s11936-020-0801-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Bernat I, Aminian A, Pancholy S, Mamas M, Gaudino M, Nolan J, Gilchrist IC, Saito S, Hahalis GN, Ziakas A, Louvard Y, Montalescot G, Sgueglia GA, van Leeuwen MA, Babunashvili AM, Valgimigli M, Rao SV, Bertrand OF. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention. JACC Cardiovasc Interv 2019; 12:2235-2246. [DOI: 10.1016/j.jcin.2019.07.043] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022]
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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: 0.4] [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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Gilchrist IC. Dorsal Radial Access: Is the Back Door to the Arterial System Ready to Be the Workhorse Entry? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:735-736. [DOI: 10.1016/j.carrev.2019.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
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