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Yang M, Jiang S, Wang Y, Meng X, Guo L, Zhang W, Zhou X, Yan Z, Li J, Dong W. Chinese expert consensus on transradial access in percutaneous peripheral interventions. J Interv Med 2023; 6:145-152. [PMID: 38312127 PMCID: PMC10831370 DOI: 10.1016/j.jimed.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 02/06/2024] Open
Abstract
Transradial access (TRA) is a safe and comfortable approach and the preferred access for percutaneous coronary intervention. However, TRA is not widely used for peripheral interventions. Currently, there is a lack of data on patient selection, appropriate medical devices, complication prevention, and TRA adoption. Therefore, the Chinese Society of Interventional Oncology of the China Anti-Cancer Association organized nationwide experts to establish a Working Group of China Expert Consensus on TRA in percutaneous peripheral interventions in 2022, and jointly formulated this consensus to better promote the application of TRA in peripheral interventions to guide clinicians on patient selection, technical recommendations, and physician training. This consensus mainly focuses on the current situation, advantages and limitations of TRA in peripheral interventions, anatomical characteristics of the radial artery, patient selection, technical aspects, prevention and management of complications, radiation dose, and learning curve. A consensus was reached through a literature evaluation and by referring to the opinions of the expert group.
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Affiliation(s)
- Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Sen Jiang
- Department of Radiology, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Yangpu District, Shanghai, China
| | - Yanli Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, Zhengzhou, China
| | - Xiaoxi Meng
- Department of Interventional Radiology, Shanghai Changzheng Hospital, 415 Feng Yang Road, Huangpu District, Shanghai, China
| | - Liwen Guo
- Department of Interventional Radiology, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Jiarui Li
- Department of Interventional Radiology, The First Hospital of Jilin University, 71 Xinmin Street, Chaoyang District, Changchun, China
| | - Weihua Dong
- Department of Interventional Radiology, Shanghai Changzheng Hospital, 415 Feng Yang Road, Huangpu District, Shanghai, China
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Jiang F, Fan WL, Zheng W, Wu X, Hu H. Distal radial artery access is a safe and feasible technique in the anatomical snuffbox for visceral intervention. Medicine (Baltimore) 2023; 102:e33987. [PMID: 37327275 PMCID: PMC10270534 DOI: 10.1097/md.0000000000033987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
Regarding the site of arterial access during the intervention, transracial intervention can reduce the risk of bleeding and vessel-related complications as well as improve patient comfort. Importantly, the distal radial artery (DRA) approach may reduce the incidence of radial artery occlusion and digital ischemia, but the feasibility and safety of DRA in performing subdiaphragmatic vascular interventions remain unclear. From January 2018 to December 2019, 106 patients were admitted to our department for visceral angiography and intervention by left distal radial artery accessing in an anatomical snuffbox. In total, 152 times of vascular interventions were performed during this period. Patients demographics, procedure details, technical success, and access site-related complications were recorded and evaluated. The mean age was 58.9 (range 22-86) years. Males accounted for 80.2%. Thirty-five patients (33%) had 2 or more procedures via the DRA approach. Technical success was achieved for 96.1% of procedures (146 cases) and 3.9% of cases failed to perform the intended procedure via the DRA approach (6 cases). The 4-Fr sheath was used in 86.8% of cases, and the 5 Fr sheath was used in the rest of the 13.2% of procedures. The rate of asymptomatic radial artery occlusion was 5.7% (6 of 106 patients). No patient suffered from distal limb ischemia after a long-time follow-up. Eight patients suffered postoperative local pain, transient numbness, or local bruised in the anatomical snuffbox without major complications. Patients with postoperative complications recovered quickly by using nonsteroidal anti-inflammatory drugs or without further treatment. Left distal radial artery access is safe and feasible as a new technique for visceral angiography and intervention.
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Affiliation(s)
- Feng Jiang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wen-Long Fan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Aimo A, Coceani MA, Ciardetti M, Teresi L, Pastormerlo LE, Palmieri C. Revascularization of coronary and left popliteal artery lesions from the same radial arterial access. J Cardiovasc Med (Hagerstown) 2023; 24:317-319. [PMID: 36957983 DOI: 10.2459/jcm.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa
- Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy
| | | | - Marco Ciardetti
- Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy
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Xu R, Nair SK, Xia Y, Liew J, Vo C, Yang W, Feghali J, Alban T, Tamargo RJ, Chanmugam A, Huang J. Risk factor guided early discharge and potential resource allocation benefits in patients with traumatic subarachnoid hemorrhage. World Neurosurg 2022; 163:e493-e500. [PMID: 35398576 DOI: 10.1016/j.wneu.2022.04.014] [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: 03/23/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to develop screening criteria predicting the lack of poor neurological outcomes in patients presenting with traumatic subarachnoid hemorrhage (tSAH), while evaluating their potential to improve resource-allocation in these cases. METHODS We retrospectively reviewed patients presenting with tSAH to the emergency department (ED) of a tertiary care institution from 2016-2018. We defined good neurological outcomes as patients with stable/improving neurological status, did not require neurosurgical intervention, no expanding bleed, and no hospital readmission. Univariate and multivariate models were generated to predict risk factors inversely associated with good neurological outcome. RESULTS 167 patients presented with tSAH from 2016-2018. The presence of depressed skull fracture, concomitant spinal fracture, low GCS, cranial nerve palsies, disorientation, concomitant hemorrhages, midline shift (MLS), elevated INR, and emergent medical intervention were inversely correlated with likelihood of good neurological outcome upon univariate analysis. Multivariate regression demonstrated that midline shift [OR=0.22 (0.05-0.89), p=0.04], GCS <13 [OR=0.22 (0.05-0.99), p=0.05], elevated INR [OR=0.18 (0.03-0.85), p=0.04], and emergent medical intervention [OR=0.18 (0.04-0.63), p=0.01] were independently associated with lower likelihood of good neurological outcome. 46 patients without any factors had good outcomes but were held in the ED or admitted to the hospital. These patients - if instead discharged directly - translated to a potential cost savings of $179,172. CONCLUSIONS In our study we found multiple risk factors inversely associated with good neurological outcome, namely low GCS, midline shift, emergent medical intervention, and INR ≥ 1.4. Our findings may aid clinicians in determining which tSAH patients are candidates for safe early discharge.
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Goldman DT, Bageac D, Mills A, Yim B, Yaeger K, Majidi S, Kellner CP, De Leacy RA. Transradial Approach for Neuroendovascular Procedures: A Single-Center Review of Safety and Feasibility. AJNR Am J Neuroradiol 2021; 42:313-318. [PMID: 33446499 DOI: 10.3174/ajnr.a6971] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In recent years, the transradial approach has become more widely adopted for neuroendovascular procedures. The purpose of this study was to evaluate the safety and feasibility of a transradial approach and distal transradial access for neuroendovascular procedures in a single center. MATERIALS AND METHODS Retrospective analysis was performed for all patients who underwent transradial approach or distal transradial access neuroendovascular procedures from January 2016 to August 2019 at a single center. Exclusion criteria included a Barbeau D waveform, a radial artery of <2 mm on sonographic evaluation, and known radial artery occlusion. Procedures were evaluated for technical success (defined as successful radial artery access and completion of the intended procedure without crossover to an auxiliary access site), complications, and adverse events during follow-up at 30 days. RESULTS The transradial approach or distal transradial access was attempted in 279 consecutive patients (58.1% women; median age, 57.7 years) who underwent 328 standard or distal transradial approach procedures. Two-hundred seventy-nine transradial approach and 49 distal transradial approach procedures were performed (cerebral angiography [n = 213], intracranial intervention [n = 64], head and neck intervention [n = 30], and stroke intervention [n = 21]). Technical success was 92.1%. Immediate adverse events (2.1%) included radial access site hematoma (n = 5), radial artery occlusion (n = 1), and acute severe radial artery spasm (n = 1). Thirty-day adverse events (0.3%) included a radial artery pseudoaneurysm (n = 1). Twenty-six cases (7.9%) required crossover to transfemoral access. CONCLUSIONS The transradial approach for neuroendovascular procedures is safe and feasible across a wide range of neuroendovascular interventions.
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Affiliation(s)
- D T Goldman
- From the Departments of Radiology (D.T.G., R.A.D.L.)
| | - D Bageac
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - A Mills
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - B Yim
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - K Yaeger
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - S Majidi
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - C P Kellner
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - R A De Leacy
- From the Departments of Radiology (D.T.G., R.A.D.L.)
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
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Access Site for Visceral Arterial Interventions: Point-Transradial Is the Future. AJR Am J Roentgenol 2020; 217:27-28. [PMID: 33295799 DOI: 10.2214/ajr.20.25175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shan DK, Truong H, Tarabey S, Hamilton C, Rahimi SA, Beckerman WE. Giant visceral artery pseudoaneurysm treated with endovascular transradial coil embolization. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:618-621. [PMID: 33163745 PMCID: PMC7599377 DOI: 10.1016/j.jvscit.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022]
Abstract
Visceral artery pseudoaneurysms (PSAs) are relatively rare, and cases associated with distal vasculature of the superior mesenteric artery are largely unreported. Visceral artery PSAs, without intervention, can lead to morbidity or mortality from rupture or mesenteric ischemia. Historically, open aneurysmectomy is the gold standard; however, endovascular modalities have emerged as the first-line treatment in patients who are poor surgical candidates and/or have unfavorable anatomy. Herein, we describe a case of a symptomatic PSA of the distal superior mesenteric artery treated via the transradial approach with endovascular coil embolization, showing successful aneurysmal exclusion and preservation of enteric collateral flow.
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Affiliation(s)
- Deepak K Shan
- Drexel University College of Medicine, Philadelphia, Pa
| | - Huong Truong
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Sally Tarabey
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Charles Hamilton
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - Saum A Rahimi
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
| | - William E Beckerman
- Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson, New Brunswick, NJ
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Patel A, Sare A, Shahid MU, Kumar A, Shukla PA. Safety and Feasibility of Transradial Access in Patients Presenting With Traumatic Injuries: A Single Urban Center Experience. Vasc Endovascular Surg 2020; 54:665-669. [PMID: 32720585 DOI: 10.1177/1538574420940088] [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: 11/17/2022]
Abstract
PURPOSE To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. MATERIALS AND METHODS A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. RESULTS Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site-related complications. CONCLUSION Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.
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Affiliation(s)
- Aesha Patel
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Antony Sare
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Muhammad U Shahid
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Abhishek Kumar
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Pratik A Shukla
- Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
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van Dam L, Geeraedts T, Bijdevaate D, van Doormaal PJ, The A, Moelker A. Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique. J Vasc Interv Radiol 2019; 30:1281-1285. [PMID: 31142436 DOI: 10.1016/j.jvir.2019.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate safety and feasibility of distal radial artery (DRA) access for noncoronary interventional radiology procedures. MATERIALS AND METHODS All interventional radiology procedures by means of DRA puncture from July 2017 to August 2018 were retrospectively reviewed. Eighty-two punctures in 56 patients were included, mostly in male patients (84% vs 16%). Mean age was 67.8 years (range, 33.3-87.3 years); mean height was 172 cm (range, 142-190 cm); and mean weight was 83 kg (range, 43-120 kg). Procedural characteristics, technical success, and complication rates were gathered from the medical records and follow-up ultrasound when available. Prerequisites for DRA access were adequate radioulnar collateral circulation, sufficient radial artery diameter, and informed consent in patients initially intended for conventional transradial access. RESULTS Procedures included transarterial chemoembolization (n = 34), yittrium-90 pretreatment angiography (n = 21), yittrium-90 administration (transarterial radioembolization; n = 20), and embolization of visceral organs (n = 7). Both 4-Fr (n = 35) and 5-Fr (n = 46) sheaths were used. Technical success of DRA access was 97.6%, with conversion to transfemoral access in 2 cases (2.4%). No major complications were reported as a result of DRA access. CONCLUSION DRA access is a feasible and safe technique for abdominal interventional radiology embolization procedures. No radial artery occlusion or other major complications were observed in patients who underwent follow-up ultrasound.
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Affiliation(s)
- Lievay van Dam
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands, Gravendijkwal 230, Rotterdam 3015 CE, Netherlands.
| | - Tychon Geeraedts
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands, Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
| | - Diederick Bijdevaate
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands, Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
| | - Pieter Jan van Doormaal
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands, Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
| | - Ayleen The
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands, Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands, Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
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Posham R, Young LB, Lookstein RA, Pena C, Patel RS, Fischman AM. Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools? Semin Intervent Radiol 2019; 35:427-434. [PMID: 30728658 DOI: 10.1055/s-0038-1676341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The benefits of transradial arterial access (TRA) versus transfemoral arterial access (TFA) have been extensively described in the literature; however, TFA remains the predominant access site choice in the management of peripheral arterial disease (PAD). There are still significant unmet needs for operators wishing to provide the same effective interventions for lower extremity PAD via TRA as with TFA. This article provides an up-to-date review of the literature and devices currently available for operators wishing to treat lower extremity PAD via TRA and the limitations they may face.
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Affiliation(s)
| | | | | | | | - Rahul S Patel
- Icahn School of Medicine at Mount Sinai, New York, New York
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