Feasibility and safety of coronary catheterization with the distal radial approach for hemodialysis patients

Feasibility and safety of the distal radial access for vascular access interventional therapy

Distal radial access (DRA) has emerged as an alternative approach to reduce the risk of radial artery occlusion in coronary angiography. Vascular access intervention therapy (VAIVT) is traditionally used to treat arteriovenous fistula stenosis. However, the feasibility and safety of DRA for VAIVT have not been established. This study aimed to evaluate the feasibility and safety of using DRA for VAIVT. We included 421 consecutive VAIVT procedures for upper limb arteriovenous fistulas retrospectively. DRA for VAIVT was performed in 181 procedures (DRA group), and the remaining procedures were approached through the brachial artery or vein (SA group: standard access group). Clinical follow-up was performed to evaluate the incidence of hematoma and dialysis access-associated steal syndrome (DASS). The mean follow-up duration following VAIVT was 24.0 months. The VAIVT success rate did not differ significantly between the groups (DRA: 97.8% vs. SA: 98.3%; P = 0.73), neither did the incidence of puncture site hematoma (DRA: 0.0% vs. SA: 0.8%; P = 0.51). There were no complications with DASS symptoms in the DRA group during the clinical follow-up. In the DRA group, 90 patients underwent a subsequent VAIVT procedure, and 85 patients (94.4%) underwent a subsequent VAIVT by DRA. DRA is a feasible and safe strategy for VAIVT and could be considered an option for VAIVT.

Feasibility of Distal Radial Access in High Bleeding Risk Patients Who Underwent Percutaneous Coronary Intervention

BACKGROUNDS AND OBJECTIVES

The distal radial access (DRA), a potential alternative to the trans-radial approach (TRA), may offer advantages in terms of access site complications due to its smaller vessel diameter, especially for high bleeding risk (HBR) patients. This study aims to investigate the feasibility of DRA in HBR patients.

METHODS

Based on data from the KODRA registry, a prospective, multicenter cohort, this study analyzed 1,586 patients who underwent successful percutaneous coronary intervention (PCI) via DRA. Patients were categorized into HBR and non-HBR groups. The primary endpoint of the study is DRA-related bleeding, and the secondary endpoints of the study are overall access site complications and each component of the access site complications. To reduce the effect of potential confounders, a multivariable adjustment analysis was performed.

RESULTS

The mean age of the total population was 71.1±10.8 years, and 40.3% of patients were female. Both DRA-related bleeding (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67-1.97; p=0.616) and overall access site complications (OR, 1.08; 95% CI, 0.67-1.72; p=0.761) were not significantly different between the HBR group and non-HBR group after multivariable adjustment. No major bleeding before discharge was observed in both groups. Furthermore, the incidence of distal and conventional radial artery occlusion was less than 1% at 1-month follow-up in both groups.

CONCLUSIONS

Our study results showed the safety of DRA for both DRA-related bleeding and access site complications among HBR patients who underwent PCI.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04080700.

Successful creation and long-term usage of radiocephalic fistula based on the recanalized completely occluded radial artery

The total occlusion of radial artery is a contraindication for reintervention and further usage. In this study, we report successful revascularization with creation of radiocephalic fistula from post-procedural chronically-occluded radial artery. The completely occluded radial artery was recanalized through ultrasound guided balloon angioplasty. A traditional radiocephalic fistula was created subsequently by using the recanalized radial artery for hemodialysis therapy. Though the fistula was failed at the 6 weeks caused by the juxta anastomotic stenosis, the further ultrasound guided percutaneous transluminal angioplasty restored the blood, and the hemodialysis therapy lasts for more than 1 year so far. It's feasible to create radiocephalic fistula based on the recanalized radial artery and maintain long-term hemodialysis therapy.